Provider Demographics
NPI:1063403673
Name:DAVIS, JULIAN SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2635
Mailing Address - Country:US
Mailing Address - Phone:516-437-3689
Mailing Address - Fax:516-775-1462
Practice Address - Street 1:1040 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 11
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2635
Practice Address - Country:US
Practice Address - Phone:516-437-3689
Practice Address - Fax:516-775-1462
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002424213E00000X
FL634213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340499400Medicaid
NY00401405Medicaid
FLU1987Medicare ID - Type Unspecified
T50765Medicare UPIN
FL340499400Medicaid