Provider Demographics
NPI:1013300987
Name:SIYONOV, JULIA
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:SIYONOV
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 1:10850 62ND DR
Mailing Address - Street 2:# 5E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1261
Mailing Address - Country:US
Mailing Address - Phone:347-217-3399
Mailing Address - Fax:718-504-3950
Practice Address - Street 1:10850 62ND DR
Practice Address - Street 2:# 5E
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1261
Practice Address - Country:US
Practice Address - Phone:347-217-3399
Practice Address - Fax:718-504-3950
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2532381171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor