Healthcare Provider Details

I. General information

NPI: 1235033689
Provider Name (Legal Business Name): MR. MERVYN ADRIAN JOSEPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

166 POLK ST APT 4
SYRACUSE NY
13224-1339
US

IV. Provider business mailing address

166 POLK ST APT 4
SYRACUSE NY
13224-1339
US

V. Phone/Fax

Practice location:
  • Phone: 315-317-2205
  • Fax:
Mailing address:
  • Phone: 315-317-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: