Provider Demographics
NPI:1548317761
Name:LOIODICE, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LOIODICE
Suffix:
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 1:487 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2233
Mailing Address - Country:US
Mailing Address - Phone:631-584-6152
Mailing Address - Fax:631-584-8063
Practice Address - Street 1:487 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2233
Practice Address - Country:US
Practice Address - Phone:631-584-6152
Practice Address - Fax:631-584-8063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0313243OtherCIGNA
NY1018319OtherAETNA
NY2418OtherVYTRA
NY5269AOtherBCBS
NY00714750Medicaid
NY9646484OtherGHI
NYCP555OtherOXFORD
NY00000379401 07OtherUNITED HEALTHCARE
NY5269AOtherBCBS
NY1018319OtherAETNA