Provider Demographics
NPI:1922602036
Name:JOSEPH, RAYNALD (APN)
Entity Type:Individual
Prefix:
First Name:RAYNALD
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7247
Mailing Address - Country:US
Mailing Address - Phone:908-265-3996
Mailing Address - Fax:
Practice Address - Street 1:868 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7247
Practice Address - Country:US
Practice Address - Phone:908-265-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403336363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health