Provider Demographics
NPI:1487749552
Name:NATHAN, JOEL A (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:A
Last Name:NATHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:SUITE 3800B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:212-410-6832
Mailing Address - Fax:877-815-2065
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:SUITE 3800B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-410-6832
Practice Address - Fax:877-815-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-03-13
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Provider Licenses
StateLicense IDTaxonomies
NY216632207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03985215Medicare Oscar/Certification