Healthcare Provider Details

I. General information

NPI: 1114168820
Provider Name (Legal Business Name): JULIA T IWAMASA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 12/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 W END AVE 21B
NEW YORK NY
10025-6230
US

IV. Provider business mailing address

752 W END AVE 21B
NEW YORK NY
10025-6230
US

V. Phone/Fax

Practice location:
  • Phone: 212-729-9353
  • Fax: 844-286-2411
Mailing address:
  • Phone: 212-729-9353
  • Fax: 844-286-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08545800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number248951-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: