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General NPI Number Information
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NPI Number | 1790675312
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Entity Type | Individual
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Provider Name | JOSHTIN DALE ORDONA SULSE
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1275 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 212-639-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7819 91ST AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2935
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Country | US
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Telephone | 347-401-0718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 777310
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 312074
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License Number State | NY
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