Healthcare Provider Details

I. General information

NPI: 1033133343
Provider Name (Legal Business Name): SATHEESH JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E MAIN ST SUITE 120
PATCHOGUE NY
11772-3114
US

IV. Provider business mailing address

325 E MAIN ST SUITE 120
PATCHOGUE NY
11772-3114
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3278
  • Fax: 631-654-1474
Mailing address:
  • Phone: 631-654-3278
  • Fax: 631-654-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number222332
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number222332
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number222332
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number222332
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02780909
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier729P11
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE BLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: