Provider Demographics
NPI:1053481622
Name:KANJI, JULIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:
Last Name:KANJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-427-1100
Mailing Address - Fax:631-784-7748
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-427-1100
Practice Address - Fax:631-784-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1720872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01393099Medicaid
NY77K001Medicare ID - Type Unspecified
NYF47464Medicare UPIN