Provider Demographics
NPI:1073956462
Name:VIOLA, JUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:VIOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:BERRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 CATHERINE STREET, PO BOX 550
Mailing Address - Street 2:EAST MANHATTAN ANESTHESIA PARTNERS LLC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-868-8411
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:301 E. 14TH STREET
Practice Address - Street 2:NY EYE & EAR INFIRMARY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-979-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY284402-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY196807504OtherSTATE ID