Provider Demographics
NPI:1275022402
Name:MUMFORD, JULIE EILEEN
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:EILEEN
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FOUR CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3019
Mailing Address - Country:US
Mailing Address - Phone:845-729-1914
Mailing Address - Fax:
Practice Address - Street 1:57 FOUR CORNERS RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3019
Practice Address - Country:US
Practice Address - Phone:845-729-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist