Basic Information
| Provider Information | |||||||||
| NPI: | 1730280348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOGEL | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000-2433 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191952433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124630101 | ||||||||
| FaxNumber: | 2124630952 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100111611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124630101 | ||||||||
| FaxNumber: | 2124630952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 156790 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 011591316 | 05 | NY | MEDICAID |