Provider Demographics
NPI:1780949362
Name:MATYASIK, JULIE CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:CHRISTINE
Last Name:MATYASIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:C
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 W KENNEDY ST
Mailing Address - Street 2:BEARD SCHOOL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-435-4276
Mailing Address - Fax:315-435-6553
Practice Address - Street 1:220 W KENNEDY ST
Practice Address - Street 2:BEARD SCHOOL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1057
Practice Address - Country:US
Practice Address - Phone:315-435-4276
Practice Address - Fax:315-435-6553
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY858050981172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker