Provider Demographics
NPI:1215136171
Name:STABINER, JULIE L (MPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:STABINER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 BEACH 141 STREET
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1234
Mailing Address - Country:US
Mailing Address - Phone:917-673-4278
Mailing Address - Fax:
Practice Address - Street 1:256 BEACH 141 STREET
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1234
Practice Address - Country:US
Practice Address - Phone:917-673-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12327-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6699429OtherGHI
NYQ43561OtherEMPIRE
NYQ43561OtherEMPIRE