Provider Demographics
NPI:1407477102
Name:OLSTEIN, JULIA ANNE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:OLSTEIN
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 1:315 W 57TH ST APT 9D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3142
Mailing Address - Country:US
Mailing Address - Phone:917-363-7955
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7206
Practice Address - Country:US
Practice Address - Phone:212-579-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061815122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist