Provider Demographics
NPI:1194814004
Name:MACIEJEWSKI, JULIANE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIANE
Middle Name:MARIE
Last Name:MACIEJEWSKI
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 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1244
Mailing Address - Country:US
Mailing Address - Phone:716-592-2832
Mailing Address - Fax:716-881-6247
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02661425Medicaid
I 20785Medicare UPIN
NY02661425Medicaid