Provider Demographics
NPI:1316950397
Name:MORGAN, JULIE MASON (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MASON
Last Name:MORGAN
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 1:41 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1857
Mailing Address - Country:US
Mailing Address - Phone:516-674-0153
Mailing Address - Fax:
Practice Address - Street 1:21 E 22ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5332
Practice Address - Country:US
Practice Address - Phone:212-460-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01413001Medicaid
NYJM1053K490Medicare PIN
NY01413001Medicaid