Healthcare Provider Details

I. General information

NPI: 1467435271
Provider Name (Legal Business Name): ANTONIO JOSEPH JR. M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

PO BOX 516
VALLEY STREAM NY
11582-0516
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-6433
  • Fax: 718-949-0331
Mailing address:
  • Phone: 516-285-2850
  • Fax: 516-285-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number176371
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number176371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: