Healthcare Provider Details

I. General information

NPI: 1194629444
Provider Name (Legal Business Name): JOYFUL MEDICAL OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W JERICHO TPKE STE 107E
SMITHTOWN NY
11787-3220
US

IV. Provider business mailing address

102 S UNION ST
ALEXANDRIA VA
22314-3324
US

V. Phone/Fax

Practice location:
  • Phone: 571-554-2565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GRACE LUNDT
Title or Position: OPERATIONS
Credential:
Phone: 571-554-2565