Provider Demographics
NPI:1215993290
Name:JOSEPH, BRIAN S (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5820 MAIN ST
Mailing Address - Street 2:206
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5776
Mailing Address - Country:US
Mailing Address - Phone:716-633-5997
Mailing Address - Fax:716-634-2595
Practice Address - Street 1:5820 MAIN ST
Practice Address - Street 2:206
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5776
Practice Address - Country:US
Practice Address - Phone:716-633-5997
Practice Address - Fax:716-634-2595
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1044642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00735740Medicaid
NY1507230OtherINDEPENDENT HEALTH INSURA
NYME0350668042OtherMED EDUCATION NUMBER
NY00020911101OtherUNIVERA INSURANCE
NY00020911101OtherUNIVERA INSURANCE