John Ponnampel Joseph
Individual provider Active NPI Registered Nurse · Bellrose, NY
NPI 1124396841 · NPPES record last updated Dec 8, 2011
Key facts
- NPI
- 1124396841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 641207-1 (NY)
- Practice address
- 247-78 77 Crescent
Apt B
Bellrose, NY 11426 - Phone
- (718) 831-1201
- NPI assigned
- Dec 8, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 641207-1 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 641207-1 | NY | Yes |
Addresses
Primary practice location
247-78 77 Crescent
Apt B
Bellrose, NY 11426
Mailing address
247-78 77 Crescent
Apt B
Bellrose, NY 11426
Phone (718) 831-1201
Other providers in Bellrose, NY
All providers in Bellrose, NY · Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.