Provider Demographics
NPI:1609840974
Name:MADEJSKI, JULIE A (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MADEJSKI
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 1:5846 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-433-3053
Mailing Address - Fax:716-433-3118
Practice Address - Street 1:5846 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-433-3053
Practice Address - Fax:716-433-3118
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2007041207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524651002OtherBSWNY
NY0709051OtherINDEP HEALTH
5422459OtherAETNA
NYJ400080377OtherMEDICARE PTAN
NY00010301401OtherUNIVERA
0271172OtherMVP/CIGNA
NY01735648Medicaid
0299692OtherGHI
NY01735648Medicaid