Provider Demographics
NPI:1659719912
Name:FERNANDEZ, JULIE M (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:DEKOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:780 ROUTE 37 W
Practice Address - Street 2:SUITE 140
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-240-6400
Practice Address - Fax:732-240-6420
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00579100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist