Provider Demographics
NPI:1922099167
Name:SANDRUCK, JULIE C (MD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:C
Last Name:SANDRUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:C
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:125 WHITE SPRUCE BLVD # 600
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1607
Mailing Address - Country:US
Mailing Address - Phone:585-461-5940
Mailing Address - Fax:585-461-2325
Practice Address - Street 1:125 WHITE SPRUCE BLVD # 600
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1607
Practice Address - Country:US
Practice Address - Phone:585-461-5940
Practice Address - Fax:585-461-2325
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2439711207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI08501Medicare UPIN
NYRB6077Medicare PIN
MASA A36871Medicare ID - Type Unspecified