1053343145 NPI number — JOSHUA A KING M.D.

Table of content: JOSHUA A KING M.D. (NPI 1053343145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053343145 NPI number — JOSHUA A KING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
JOSHUA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053343145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 EXECUTIVE PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12203-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-438-1434
Provider Business Mailing Address Fax Number:
518-489-1205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-438-1434
Provider Business Practice Location Address Fax Number:
518-489-1205
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  188838 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01559315 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006084 . This is a "VERMONT MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67220 . This is a "GHI HMO SELECT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000406597003 . This is a "BS NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10001067 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 141826445 . This is a "HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 19202 . This is a "MVP HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00040528801 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: JK04611610 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20121600 . This is a "FIDELIS CARE NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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