MEDICARE: DR. HAROLD THIBOU JOSEPH MD

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	207Q00000X	Family Medicine Physician	096052	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851411573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD THIBOU JOSEPH MD

Provider Business Mailing Address
First Line	:	12 NEW LANE
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-3322
Country	:	US
Telephone Number	:	631-451-0200
Fax Number	:	631-716-1984

Provider Business Practice Location Address
First Line	:	12 NEW LANE
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-3322
Country	:	US
Telephone Number	:	631-451-0200
Fax Number	:	631-716-1984

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/04/2008

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