Provider Demographics
NPI:1457440372
Name:WOODLE, JOANNE SLOCUM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:SLOCUM
Last Name:WOODLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2231 INDIAN NECK LANE
Mailing Address - Street 2:
Mailing Address - City:PECONIC
Mailing Address - State:NY
Mailing Address - Zip Code:11958
Mailing Address - Country:US
Mailing Address - Phone:631-734-4066
Mailing Address - Fax:
Practice Address - Street 1:2213 INDIAN NECK LN
Practice Address - Street 2:
Practice Address - City:PECONIC
Practice Address - State:NY
Practice Address - Zip Code:11958-1723
Practice Address - Country:US
Practice Address - Phone:631-734-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1459782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78819Medicare UPIN