Healthcare Provider Details

I. General information

NPI: 1861617839
Provider Name (Legal Business Name): JOSEPH TRAPP RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NORTH RD WILTON FAMILY MEDICINE
WILTON NY
12831-1308
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1965
  • Fax: 518-926-4804
Mailing address:
  • Phone: 518-926-1935
  • Fax: 518-926-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: