Provider Demographics
NPI:1891438800
Name:JOSEPH, STEPHAN LUDOVIC (DPM)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:LUDOVIC
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:347-577-4410
Mailing Address - Fax:347-557-4596
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:347-577-4410
Practice Address - Fax:347-577-4596
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program