Provider Demographics
NPI:1043669021
Name:JOSEPH, JOJO (MD)
Entity type:Individual
Prefix:
First Name:JOJO
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 1:122 SMITH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7735
Mailing Address - Country:US
Mailing Address - Phone:845-893-7002
Mailing Address - Fax:
Practice Address - Street 1:CARIBBEAN CINEMA, SUITE 109
Practice Address - Street 2:PLAZA ESCORIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:845-893-7002
Practice Address - Fax:787-752-2487
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19215208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice