Provider Demographics
NPI:1669835724
Name:POTTER, JOSHUA (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 SPRINGVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-283-1126
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:44 SOUTH FERRY ROAD
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964
Practice Address - Country:US
Practice Address - Phone:631-749-9140
Practice Address - Fax:631-759-9424
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY303563207Q00000X, 208M00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06020593Medicaid