=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487699260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA YVONNE OWEIS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2006
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 CREEK LN
-----------------------------------------------------
City | OYSTER BAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11771-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-778-0022
-----------------------------------------------------
Fax | 516-226-1871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 97
-----------------------------------------------------
City | BAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11709-0097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-778-0022
-----------------------------------------------------
Fax | 516-226-1871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 211304
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------