MEDICARE: JULIE MADLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		NY
2	101YM0800X	Mental Health Counselor	18006707	NY

General Provider Information

NPI Number	:	1184822405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MADLIN

Provider Business Mailing Address
First Line	:	15 UPLAND RD
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2521
Country	:	US
Telephone Number	:	206-696-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 E 17TH ST
Second Line	:	1F
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6643
Country	:	US
Telephone Number	:	206-696-1097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2007
Last Update Date	:	12/21/2016

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Directions to “ JULIE MADLIN ” Practice Location

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