Provider Demographics
NPI:1053351502
Name:MOSTOW, JOEL STEVEN (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:STEVEN
Last Name:MOSTOW
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 1:2100 NAPA VALLEJO HWY.
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6293
Mailing Address - Country:US
Mailing Address - Phone:707-253-5654
Mailing Address - Fax:707-253-5097
Practice Address - Street 1:2100 NAPA VALLEJO HWY.
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6293
Practice Address - Country:US
Practice Address - Phone:707-253-5654
Practice Address - Fax:707-253-5097
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360846952084P0800X
CAG890652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF48886Medicare UPIN