Provider Demographics
NPI:1922257062
Name:JOSEPH ABOUJAOUDE MD.PLLC
Entity Type:Organization
Organization Name:JOSEPH ABOUJAOUDE MD.PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABOUJAOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-354-3320
Mailing Address - Street 1:65 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2246
Mailing Address - Country:US
Mailing Address - Phone:718-354-3320
Mailing Address - Fax:
Practice Address - Street 1:65 ROSE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2246
Practice Address - Country:US
Practice Address - Phone:718-354-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210459207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676833Medicaid
NY15N421Medicare PIN
NY01676833Medicaid