Provider Demographics
NPI:1871575878
Name:MOTTA, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MOTTA
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 1:1200 SOUTH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3413
Mailing Address - Country:US
Mailing Address - Phone:718-370-1400
Mailing Address - Fax:718-370-9290
Practice Address - Street 1:1200 SOUTH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3413
Practice Address - Country:US
Practice Address - Phone:718-370-1400
Practice Address - Fax:718-370-9290
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817963Medicaid
NY56T391Medicare ID - Type Unspecified
NY01817963Medicaid