Provider Demographics
NPI:1780603324
Name:VARGAS-JEREZ, JULIA ESPERANZA (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ESPERANZA
Last Name:VARGAS-JEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SAINT NICHOLAS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3822
Mailing Address - Country:US
Mailing Address - Phone:212-851-5494
Mailing Address - Fax:
Practice Address - Street 1:1150 SAINT NICHOLAS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3822
Practice Address - Country:US
Practice Address - Phone:212-851-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189849-1174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547162Medicaid
NYF94847Medicare UPIN
NY3X5201Medicare ID - Type Unspecified