Healthcare Provider Details

I. General information

NPI: 1073534590
Provider Name (Legal Business Name): JULIE J HIGGINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S MEADOW ST
ITHACA NY
14850-5377
US

IV. Provider business mailing address

PO BOX 248
ELLICOTTVILLE NY
14731-0248
US

V. Phone/Fax

Practice location:
  • Phone: 607-319-4563
  • Fax: 607-319-4632
Mailing address:
  • Phone: 716-699-9032
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: