MEDICARE: MADJENA FAITH JOSEPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	052833	NY

General Provider Information

NPI Number	:	1295562668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADJENA FAITH JOSEPH

Provider Business Mailing Address
First Line	:	407 ROGERS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3451
Country	:	US
Telephone Number	:	347-829-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 NEWKIRK AVE FL 5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-859-2626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	01/16/2025

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