Provider Demographics
NPI:1023178209
Name:JOSEPH, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3906
Mailing Address - Street 2:150 AARON COURT
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402
Mailing Address - Country:US
Mailing Address - Phone:845-338-6272
Mailing Address - Fax:845-338-2238
Practice Address - Street 1:150 AARON COURT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12402
Practice Address - Country:US
Practice Address - Phone:845-338-6272
Practice Address - Fax:845-338-2238
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1109712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00485209Medicaid
NY00485209Medicaid
C11669Medicare UPIN