Provider Demographics
NPI:1356987697
Name:FAJARDO RUIZ, JULIETTE MARELLA (MD)
Entity type:Individual
Prefix:DR
First Name:JULIETTE
Middle Name:MARELLA
Last Name:FAJARDO RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIETTE
Other - Middle Name:MARELLA
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3959 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-5827
Mailing Address - Fax:212-305-7086
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5827
Practice Address - Fax:212-305-7086
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3246472080N0001X
NY3476472080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine