Provider Demographics
NPI:1700947124
Name:JOSEPH, MOOLAMANNIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOOLAMANNIL
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 PELTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1908
Mailing Address - Country:US
Mailing Address - Phone:845-794-3283
Mailing Address - Fax:845-791-4153
Practice Address - Street 1:14 PELTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1908
Practice Address - Country:US
Practice Address - Phone:845-794-3283
Practice Address - Fax:845-791-4153
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1159782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry