Provider Demographics
NPI:1154749067
Name:DERFEL, JULIANA (MD)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:DERFEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:
Other - Last Name:ROSENTSVEYG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5941
Mailing Address - Country:US
Mailing Address - Phone:917-518-7873
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1102
Practice Address - Country:US
Practice Address - Phone:516-465-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY284071207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program