Provider Demographics
NPI:1699730143
Name:BATHON, JOAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:BATHON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:630 WEST 168TH STREET
Mailing Address - Street 2:10-4485
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-6213
Mailing Address - Fax:212-304-6070
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:10-445
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-6213
Practice Address - Fax:212-304-6070
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD25083207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD429801200Medicaid
MD429801200Medicaid
MDC35178Medicare UPIN