| Doctor Name: | DR. JOSE M POULOSE |
| NPI Number: | 1104905058 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D |
| License Number: | 225615 |
| Business Practice Address: | 99 Hillside Ave Ste D Williston Park, NY - 115962306 |
| Business Phone Number: | 5167392930 |
| Business Fax Number: | 5167394870 |
| Mailing Address: | 150 Lincoln Ave, MINEOLA |
| State: | NY |
| Postal Code: | 115012541 |
| Phone Number: | 5167393909 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | 225615 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |