Provider Demographics
NPI:1942899695
Name:IADAROLA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:IADAROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BOYNTON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2919
Mailing Address - Country:US
Mailing Address - Phone:917-816-6435
Mailing Address - Fax:
Practice Address - Street 1:1250 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1943
Practice Address - Country:US
Practice Address - Phone:917-397-8947
Practice Address - Fax:929-226-6026
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency