=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548820699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA DAVID
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2019
-----------------------------------------------------
Last Update Date | 06/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22004 LINDEN BLVD
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-712-3358
-----------------------------------------------------
Fax | 888-352-0588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22004 LINDEN BLVD
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-712-3358
-----------------------------------------------------
Fax | 888-352-0588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------