Provider Demographics
NPI:1104442458
Name:SOUTH STREET HEALTH SERVICES FAMILY HEALTH AND PSYCHIATRY NPS PLLC
Entity type:Organization
Organization Name:SOUTH STREET HEALTH SERVICES FAMILY HEALTH AND PSYCHIATRY NPS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:716-727-0099
Mailing Address - Street 1:17 KINGSTON CIR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5606
Mailing Address - Country:US
Mailing Address - Phone:716-727-0099
Mailing Address - Fax:
Practice Address - Street 1:8-12 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1409
Practice Address - Country:US
Practice Address - Phone:716-797-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty