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General NPI Number Information
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NPI Number | 1447399613
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Entity Type | Individual
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Provider Name | JULIE ANNE CONNOLLY DDS, MPH, MS
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 654 MADISON AVE SUITE 1005
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City | NEW YORK
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State | NY
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Zip | 10021-8404
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Country | US
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Telephone | 212-888-7477
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Fax | 212-758-8451
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Provider Business Mailing Address
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Address Line | 115 E 61ST ST 8TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10065-8183
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Country | US
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Telephone | 212-888-7477
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Fax | 212-758-8451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 050465-1
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License Number State | NY
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