MEDICARE: DR. JULIANA EKONG M.D.

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	2084P0800X	Psychiatry Physician	208531	NY

General Provider Information

NPI Number	:	1710425632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIANA EKONG M.D.

Provider Business Mailing Address
First Line	:	347 W 37TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-4202
Country	:	US
Telephone Number	:	212-586-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	643 PARK AVE
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10065-6122
Country	:	US
Telephone Number	:	212-218-0500
Fax Number	:

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

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	02/22/2017

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