Basic Information
| Provider Information | |||||||||
| NPI: | 1508896507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E MIDDLE COUNTRY RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117872814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312651622 | ||||||||
| FaxNumber: | 6312653042 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 E MIDDLE COUNTRY RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117872814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312651622 | ||||||||
| FaxNumber: | 6312653042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 125793 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 125793-OB | 01 | NY | WORKERS COMP | OTHER | 3034436 | 01 | NY | OXFORD | OTHER |