Provider Demographics
NPI:1255915476
Name:DEASSIS, JOSEPH MANUEL
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MANUEL
Last Name:DEASSIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 KRAMER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4275
Mailing Address - Country:US
Mailing Address - Phone:347-924-0593
Mailing Address - Fax:
Practice Address - Street 1:289 KRAMER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-4275
Practice Address - Country:US
Practice Address - Phone:347-924-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program