Basic Information
Provider Information
NPI: 1053351502
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOSTOW
FirstName: JOEL
MiddleName: STEVEN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 NAPA VALLEJO HWY.
Address2:  
City: NAPA
State: CA
PostalCode: 945586293
CountryCode: US
TelephoneNumber: 7072535654
FaxNumber: 7072535097
Practice Location
Address1: 2100 NAPA VALLEJO HWY.
Address2:  
City: NAPA
State: CA
PostalCode: 945586293
CountryCode: US
TelephoneNumber: 7072535654
FaxNumber: 7072535097
Other Information
ProviderEnumerationDate: 06/06/2006
LastUpdateDate: 01/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X036084695ILN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800XG89065CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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