Provider Demographics
NPI:1467483958
Name:OVSHAYEV, JULIET (DO)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:OVSHAYEV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MELNICK DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-352-9292
Mailing Address - Fax:845-352-1252
Practice Address - Street 1:6 MELNICK DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:845-352-9292
Practice Address - Fax:845-352-1252
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220616207Q00000X
NJ25MB07494800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199631Medicaid
H46184Medicare UPIN
NY02199631Medicaid