Provider Demographics
NPI:1679506034
Name:TOBAK, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:TOBAK
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 1:195 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1215
Mailing Address - Country:US
Mailing Address - Phone:914-804-8535
Mailing Address - Fax:914-722-1502
Practice Address - Street 1:700 WHITE PLAINS RD STE 19
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5013
Practice Address - Country:US
Practice Address - Phone:914-804-8535
Practice Address - Fax:914-722-1502
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212064207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02389917Medicaid
NY3V8531Medicare ID - Type Unspecified
NY02389917Medicaid