Provider Demographics
NPI:1679058366
Name:MATCHAM, JOSEPH ISAIAH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ISAIAH
Last Name:MATCHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1326
Mailing Address - Country:US
Mailing Address - Phone:914-355-7417
Mailing Address - Fax:
Practice Address - Street 1:85 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1326
Practice Address - Country:US
Practice Address - Phone:914-355-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator