Provider Demographics
NPI:1447560628
Name:JEMIOLO, URSULA (PA)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:
Last Name:JEMIOLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 OCEAN AVE APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3155
Mailing Address - Country:US
Mailing Address - Phone:917-470-4442
Mailing Address - Fax:
Practice Address - Street 1:281 1ST AVE
Practice Address - Street 2:BETH ISRAEL MEDICAL CENTER DEPT OF EMERGENCY MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2925
Practice Address - Country:US
Practice Address - Phone:212-420-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014401OtherNY STATE DEPT OF EDUCATION LICENSE NUMBER