Healthcare Provider Details

I. General information

NPI: 1952447351
Provider Name (Legal Business Name): JOSEPH HADDAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COLUMBUS AVE STE 2
NEW YORK NY
10024-1459
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 212-600-9411
  • Fax: 917-441-6829
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number160646
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number160646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: