Basic Information
| Provider Information | |||||||||
| NPI: | 1205839495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTIANA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5801 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100875801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145937880 | ||||||||
| FaxNumber: | 9145937881 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 GRAND ST | ||||||||
| Address2: | STE 106 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124013933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453398700 | ||||||||
| FaxNumber: | 9145937881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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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 | 207RC0000X | 207897 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 400P0X0942 | 01 | NY | PTAN | OTHER | 02147515 | 05 | NY | MEDICAID | 400P032241 | 01 | NY | PTAN | OTHER | 060063770 | 01 | NY | RAIL ROAD MEDICARE | OTHER | 400P033642 | 01 | NY | PTAN | OTHER | 400P0X0943 | 01 | NY | PTAN | OTHER |