Basic Information
| Provider Information | |||||||||
| NPI: | 1003968132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | LA | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 CROWELL ST | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115505113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165388697 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4295 HEMPSTEAD TPKE | ||||||||
| Address2: | |||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117145713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165796000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 008600 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.