Provider Demographics
NPI:1316939226
Name:SPIVACK, JULIE E (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:E
Last Name:SPIVACK
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 1:425 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6232
Mailing Address - Country:US
Mailing Address - Phone:203-292-9000
Mailing Address - Fax:203-292-1700
Practice Address - Street 1:425 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6232
Practice Address - Country:US
Practice Address - Phone:203-292-9000
Practice Address - Fax:203-292-1700
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG41672Medicare UPIN