Provider Demographics
NPI:1740302538
Name:STUDIN, JOEL ROY (MD FACS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROY
Last Name:STUDIN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BARSTOW RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2229
Mailing Address - Country:US
Mailing Address - Phone:516-482-8008
Mailing Address - Fax:
Practice Address - Street 1:15 BARSTOW RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2229
Practice Address - Country:US
Practice Address - Phone:516-482-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64987Medicare UPIN