Provider Demographics
NPI:1912774092
Name:SOUZA, JOSEPH P
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:SOUZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MOUNT VERNON AVE APT A-4
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1317
Mailing Address - Country:US
Mailing Address - Phone:561-801-5054
Mailing Address - Fax:
Practice Address - Street 1:72 MOUNT VERNON AVE APT A-4
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1317
Practice Address - Country:US
Practice Address - Phone:561-801-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker