Provider Demographics
NPI:1659367878
Name:JOSEPH, DELCASSE VI (MD)
Entity type:Individual
Prefix:DR
First Name:DELCASSE
Middle Name:
Last Name:JOSEPH
Suffix:VI
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0579
Mailing Address - Country:US
Mailing Address - Phone:516-377-2946
Mailing Address - Fax:516-377-2948
Practice Address - Street 1:294 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3374
Practice Address - Country:US
Practice Address - Phone:516-377-2946
Practice Address - Fax:516-377-2948
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224275208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411847Medicaid
NY02411847Medicaid
NY2629H1Medicare ID - Type Unspecified