Provider Demographics
NPI:1699347492
Name:MCTIGUE, JOY
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:MCTIGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16015 POWELLS COVE BLVD APT C7
Mailing Address - Street 2:
Mailing Address - City:BEECHHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1305
Mailing Address - Country:US
Mailing Address - Phone:347-638-9792
Mailing Address - Fax:
Practice Address - Street 1:16015 POWELLS COVE BLVD APT C7
Practice Address - Street 2:
Practice Address - City:BEECHHURST
Practice Address - State:NY
Practice Address - Zip Code:11357-1305
Practice Address - Country:US
Practice Address - Phone:347-638-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012613-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYYM16440GMedicaid