Basic Information
| Provider Information | |||||||||
| NPI: | 1649224155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISALVO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759622 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | WAPPINGERS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452972511 | ||||||||
| FaxNumber: | 8452974993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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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 | 207P00000X | 206501 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02107817 | 05 | NY | MEDICAID |