Healthcare Provider Details

I. General information

NPI: 1851955769
Provider Name (Legal Business Name): JULIE GRACE VAN BAARDWIJK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 SENECA RD N STE 109
HORNELL NY
14843-9691
US

IV. Provider business mailing address

7309 SENECA RD N STE 109
HORNELL NY
14843-9691
US

V. Phone/Fax

Practice location:
  • Phone: 786-725-8075
  • Fax:
Mailing address:
  • Phone: 607-385-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322308
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number80094-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: