Healthcare Provider Details

I. General information

NPI: 1407779077
Provider Name (Legal Business Name): TUNISIA JOSEPH
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: TUNISIA BRISTOL

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 31ST ST # 1071
ASTORIA NY
11102-1140
US

IV. Provider business mailing address

1137 31ST AVE APT 404S
ASTORIA NY
11106-4789
US

V. Phone/Fax

Practice location:
  • Phone: 917-403-5467
  • Fax:
Mailing address:
  • Phone: 917-403-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2057457261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: