Provider Demographics
NPI:1124153622
Name:JOSEPH HAYES DO LLC
Entity type:Organization
Organization Name:JOSEPH HAYES DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:NEMECEK-STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-384-0476
Mailing Address - Street 1:108 N BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2520
Mailing Address - Country:US
Mailing Address - Phone:518-384-0476
Mailing Address - Fax:518-393-8606
Practice Address - Street 1:108 N BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2520
Practice Address - Country:US
Practice Address - Phone:518-384-0476
Practice Address - Fax:518-393-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159224207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR770OtherCDPHP
NYBA0551Medicare ID - Type UnspecifiedMEDICARE
NYC59422Medicare UPIN
DF5213Medicare ID - Type UnspecifiedRAILROAD