Basic Information
Provider Information | |||||||||
NPI: | 1033133343 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JOSEPH | ||||||||
FirstName: | SATHEESH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 325 E MAIN ST | ||||||||
Address2: | SUITE 120 | ||||||||
City: | PATCHOGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117723114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316543278 | ||||||||
FaxNumber: | 6316541474 | ||||||||
Practice Location | |||||||||
Address1: | 325 E MAIN ST | ||||||||
Address2: | SUITE 120 | ||||||||
City: | PATCHOGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117723114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316543278 | ||||||||
FaxNumber: | 6316541474 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2006 | ||||||||
LastUpdateDate: | 07/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 222332 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RM1200X | 222332 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Magnetic Resonance Imaging (MRI) | 207UN0901X | 222332 | NY | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 222332 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 02780909 | 05 | NY |   | MEDICAID | 729P11 | 01 | NY | EMPIRE BLUE CROSS BLUE SHIELD | OTHER |