Provider Demographics
NPI:1831164813
Name:TOMBACK, JULIE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:TOMBACK
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 1:726 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9616
Mailing Address - Country:US
Mailing Address - Phone:212-443-1000
Mailing Address - Fax:212-443-1151
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9616
Practice Address - Country:US
Practice Address - Phone:212-443-1000
Practice Address - Fax:212-443-1000
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07781800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075582Medicaid
NY03107619Medicaid
NJ7461402Medicaid
NJ005191Medicare ID - Type UnspecifiedMEDICARE GROUP
NJ093599Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NY03107619Medicaid
NJ7461402Medicaid