Healthcare Provider Details

I. General information

NPI: 1316938822
Provider Name (Legal Business Name): JULIE BAMBARA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E MAIN ST
ENDICOTT NY
13760-5430
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790-2580
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-2323
  • Fax: 607-754-3033
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: