Healthcare Provider Details

I. General information

NPI: 1669835724
Provider Name (Legal Business Name): JOSHUA POTTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SOUTH FERRY ROAD
SHELTER ISLAND NY
11964
US

IV. Provider business mailing address

4 SPRINGVILLE RD STE B
HAMPTON BAYS NY
11946-2290
US

V. Phone/Fax

Practice location:
  • Phone: 631-749-9140
  • Fax: 631-759-9424
Mailing address:
  • Phone: 631-283-1126
  • Fax: 631-283-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303563
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number303563
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number303563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: