Provider Demographics
NPI:1831890565
Name:IANNIELLI, JULIA CHRISTINE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CHRISTINE
Last Name:IANNIELLI
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 1:2691 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3218
Mailing Address - Country:US
Mailing Address - Phone:631-404-9787
Mailing Address - Fax:
Practice Address - Street 1:2691 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3218
Practice Address - Country:US
Practice Address - Phone:631-404-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist