Provider Demographics
NPI:1285868471
Name:JOSEPH, TINA (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:625 BELLE TERRE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-689-0220
Mailing Address - Fax:631-686-7626
Practice Address - Street 1:625 BELLE TERRE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-689-0220
Practice Address - Fax:631-686-7626
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2022-02-16
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Provider Licenses
StateLicense IDTaxonomies
NY294607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery