Provider Demographics
NPI:1720269855
Name:DEFEDELE, JOSEPH LOUIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LOUIS
Last Name:DEFEDELE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4412
Mailing Address - Country:US
Mailing Address - Phone:212-865-5360
Mailing Address - Fax:212-678-4698
Practice Address - Street 1:2683 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4412
Practice Address - Country:US
Practice Address - Phone:212-865-5360
Practice Address - Fax:212-678-4698
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist