Healthcare Provider Details

I. General information

NPI: 1184581761
Provider Name (Legal Business Name): SAMMY M. JOSEPH NURSE PRACTIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 E 42ND ST
BROOKLYN NY
11210-3522
US

IV. Provider business mailing address

986 E 42ND ST
BROOKLYN NY
11210-3522
US

V. Phone/Fax

Practice location:
  • Phone: 347-244-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number580502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: