Healthcare Provider Details

I. General information

NPI: 1427492081
Provider Name (Legal Business Name): JULIA KLEIN GITTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 09/16/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL FL 11
BRONX NY
10461-2720
US

IV. Provider business mailing address

3411 WAYNE AVE FL 2
BRONX NY
10467-2535
US

V. Phone/Fax

Practice location:
  • Phone: 866-633-8255
  • Fax:
Mailing address:
  • Phone: 718-920-2680
  • Fax: 718-944-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number277620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: