Provider Demographics
NPI:1114168820
Name:IWAMASA, JULIA T (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:T
Last Name:IWAMASA
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 1:752 W END AVE
Mailing Address - Street 2:21B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6230
Mailing Address - Country:US
Mailing Address - Phone:212-729-9353
Mailing Address - Fax:844-286-2411
Practice Address - Street 1:752 W END AVE
Practice Address - Street 2:21B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6230
Practice Address - Country:US
Practice Address - Phone:212-729-9353
Practice Address - Fax:844-286-2411
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08545800207L00000X
NY248951-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology