1063560498 NPI number — MR. JOSEPH JULIANA MSW

Table of content: MR. JOSEPH JULIANA MSW (NPI 1063560498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063560498 NPI number — MR. JOSEPH JULIANA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JULIANA
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063560498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 PHILIP LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11953-2689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-914-1870
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-978-7349
Provider Business Practice Location Address Fax Number:
631-667-1708
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PRO134931 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 46025 . This is a "UNITED BEH HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7400449 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3W3210 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 070400 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R013493 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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