Provider Demographics
NPI:1639869217
Name:LOGIUDICE, JOSEPH (CRPA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LOGIUDICE
Suffix:
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAKE AMENIA RD
Mailing Address - Street 2:
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-5413
Mailing Address - Country:US
Mailing Address - Phone:845-763-6559
Mailing Address - Fax:
Practice Address - Street 1:41 PAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist