Provider Demographics
NPI:1124773403
Name:JOSEPH, TAMERA A
Entity type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 38TH ST RM 817
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3541
Mailing Address - Country:US
Mailing Address - Phone:212-695-4564
Mailing Address - Fax:
Practice Address - Street 1:307 W 38TH ST RM 817
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3541
Practice Address - Country:US
Practice Address - Phone:212-695-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker