Healthcare Provider Details

I. General information

NPI: 1487749552
Provider Name (Legal Business Name): JOEL A NATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE SUITE 3800B
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE SUITE 3800B
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-6832
  • Fax: 877-815-2065
Mailing address:
  • Phone: 212-410-6832
  • Fax: 877-815-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number216632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: