Provider Demographics
NPI:1356380612
Name:MYLOTTE, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MYLOTTE
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 1:1191 BOWEN RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9546
Mailing Address - Country:US
Mailing Address - Phone:716-655-2690
Mailing Address - Fax:716-655-2692
Practice Address - Street 1:2700 N FOREST RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1527
Practice Address - Country:US
Practice Address - Phone:716-639-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120404207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356380612OtherUNIVERA HEALTHCARE
NY3407611OtherINDEPENDENT HEALTH
NY00010124401OtherEXCELLUS UNIVERA
NY005104233OtherHEALTH NOW
NY01150852Medicaid
NY005104233OtherHEALTH NOW
NY01150852Medicaid
NYRB1916Medicare PIN