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General NPI Number Information
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NPI Number | 1245358340
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Entity Type | Organization
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Legal Business Name | JOSEPH & DESROCHES MD PC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1975 LINDEN BLVD SUITE 105
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City | ELMONT
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State | NY
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Zip | 11003-4004
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Country | US
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Telephone | 516-285-2850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | VALLEY STREAM
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State | NY
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Zip | 11582-0516
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Country | US
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Telephone | 516-285-2850
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ANTONIO JOSEPH JR.
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Credential | MD
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Telephone | 516-285-2850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 172523
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 176371
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License Number State | NY
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