Healthcare Provider Details

I. General information

NPI: 1780446591
Provider Name (Legal Business Name): ENDOCRINOLOGY MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 COLONIAL DR
HORSEHEADS NY
14845-8532
US

IV. Provider business mailing address

2395 LANCASTER PIKE, FIRST FLOOR
READING PA
19607-2375
US

V. Phone/Fax

Practice location:
  • Phone: 570-561-2982
  • Fax: 570-300-1829
Mailing address:
  • Phone: 570-561-2982
  • Fax: 570-300-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE MILLER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 585-233-2817