Provider Demographics
NPI:1457349185
Name:HEDERMAN, JOSEPH FRANCIS (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:HEDERMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 HYLAN BOULEVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4344
Mailing Address - Country:US
Mailing Address - Phone:718-351-1136
Mailing Address - Fax:718-667-9711
Practice Address - Street 1:2627 HYLAN BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4344
Practice Address - Country:US
Practice Address - Phone:718-351-1136
Practice Address - Fax:718-667-9711
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01149366Medicaid
NYAH2418742OtherDEA
NY01149366Medicaid
B12952Medicare UPIN