Provider Demographics
NPI:1912390428
Name:RO, JULIA Y (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:Y
Last Name:RO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-326-4160
Mailing Address - Fax:
Practice Address - Street 1:145 W 86TH ST. #1A
Practice Address - Street 2:ADVANCED DERMATOLOGY, PC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-601-9401
Practice Address - Fax:212-787-3078
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7519363A00000X
NY027484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant