Provider Demographics
NPI:1053343145
Name:KING, JOSHUA A (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:KING
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 1:4 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3718
Mailing Address - Country:US
Mailing Address - Phone:518-438-1434
Mailing Address - Fax:518-489-1205
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-438-1434
Practice Address - Fax:518-489-1205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01559315Medicaid
NY1006084OtherVERMONT MEDICAID
NY67220OtherGHI HMO SELECT
NY000406597003OtherBS NENY
NY10001067OtherCDPHP
NY141826445OtherHUMANA
NY19202OtherMVP HEALTH CARE
NY00040528801OtherUNIVERA HEALTHCARE
NYJK04611610OtherEMPIRE BC/BS
NY20121600OtherFIDELIS CARE NEW YORK
NYG00002Medicare UPIN
NYDD0513Medicare ID - Type Unspecified