MEDICARE: MRS. JULIE DIFABIO

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	174400000X	Specialist	452702101	NY

General Provider Information

NPI Number	:	1578976403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE DIFABIO

Provider Business Mailing Address
First Line	:	19 LAWRENCE DRIVE
Second Line	:	APT A
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604
Country	:	US
Telephone Number	:	914-629-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 LAWRENCE DR
Second Line	:	APT A
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-1341
Country	:	US
Telephone Number	:	914-629-5705
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/09/2014

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