Provider Demographics
NPI:1336206044
Name:JOSEPH, LENNY J JR
Entity Type:Individual
Prefix:MR
First Name:LENNY
Middle Name:J
Last Name:JOSEPH
Suffix:JR
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:PO BOX 4183
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47724-0183
Mailing Address - Country:US
Mailing Address - Phone:812-454-5588
Mailing Address - Fax:888-424-4394
Practice Address - Street 1:1741 OAK HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4371
Practice Address - Country:US
Practice Address - Phone:812-454-5588
Practice Address - Fax:888-424-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811860AMedicaid
IN200810190AOtherMEDICAID WAIVER