Provider Demographics
NPI:1316706906
Name:NEWMAN, JOEL A
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 CHATSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-5244
Mailing Address - Country:US
Mailing Address - Phone:407-338-6781
Mailing Address - Fax:
Practice Address - Street 1:1420 COURTLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-5436
Practice Address - Country:US
Practice Address - Phone:386-574-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11565411374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner