Individual
DR. JOEL PANTHAPPATTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
279 MAIN ST STE 102, NEW PALTZ, NY 12561-1624
(845) 255-2930
(845) 255-3089
Mailing address
396 BROADWAY, KINGSTON, NY 12401-4626
(845) 802-7600
(845) 338-0307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
296056
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
296056
NYS MEDICAL LICENSE
NY
Enumeration date
06/02/2015
Last updated
06/25/2019
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