Healthcare Provider Details

I. General information

NPI: 1912628751
Provider Name (Legal Business Name): JULIA MAI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

IV. Provider business mailing address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

V. Phone/Fax

Practice location:
  • Phone: 518-479-4156
  • Fax:
Mailing address:
  • Phone: 518-479-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: