Provider Demographics
NPI:1023156213
Name:JOSEPH, BABU M (MD)
Entity type:Individual
Prefix:DR
First Name:BABU
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27019 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1536
Mailing Address - Country:US
Mailing Address - Phone:718-343-4865
Mailing Address - Fax:718-343-4865
Practice Address - Street 1:10753 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2351
Practice Address - Country:US
Practice Address - Phone:718-523-5776
Practice Address - Fax:718-526-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377159Medicaid
NY02377159Medicaid
NYH17789Medicare UPIN