MEDICARE: JULIA RADOSSICH

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	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366066920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA RADOSSICH

Provider Business Mailing Address
First Line	:	570 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6837
Country	:	US
Telephone Number	:	646-962-7277
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	07/19/2021

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Directions to “ JULIA RADOSSICH ” Practice Location

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