Healthcare Provider Details

I. General information

NPI: 1184331837
Provider Name (Legal Business Name): JOYCE FEDERICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 WOODLOT RD
RIDGE NY
11961-1908
US

IV. Provider business mailing address

59 WOODLOT RD
RIDGE NY
11961-1908
US

V. Phone/Fax

Practice location:
  • Phone: 646-246-2473
  • Fax:
Mailing address:
  • Phone: 646-246-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number891131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: