Provider Demographics
NPI:1245226059
Name:PAOLICCHI, JULIANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:MARIE
Last Name:PAOLICCHI
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 1:690 N BROADWAY
Mailing Address - Street 2:GL1
Mailing Address - City:N WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2417
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-343-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350717642080P0008X
NY264737-12084N0402X
NJ25MA0896245002084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64955990Medicaid
NY03450699Medicaid
OH2021985Medicaid
WV0090688000Medicaid
NJ0449423Medicaid
OH2021985Medicaid
KY64955990Medicaid
NJ399682M60Medicare PIN