Provider Demographics
NPI:1841337342
Name:TIERI, JOSEPH HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:TIERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BUTTERNUT KNLS
Mailing Address - Street 2:
Mailing Address - City:WEST SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12494-5321
Mailing Address - Country:US
Mailing Address - Phone:845-657-2193
Mailing Address - Fax:
Practice Address - Street 1:3457 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5612
Practice Address - Country:US
Practice Address - Phone:845-687-7589
Practice Address - Fax:845-687-7593
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212363204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5H7011Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYH12236Medicare UPIN