Provider Demographics
NPI:1912103227
Name:CHAMBERLIN, JOE WILLIE (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:WILLIE
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 HENRY HUDSON PKWY
Mailing Address - Street 2:APARTMENT #3R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3212
Mailing Address - Country:US
Mailing Address - Phone:718-548-5819
Mailing Address - Fax:718-548-5819
Practice Address - Street 1:75 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4004
Practice Address - Country:US
Practice Address - Phone:914-376-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01518390Medicaid