Individual
MS. JULIE BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
255 EASTERN PKWY, BROOKLYN, NY 11238-6370
(718) 636-8291
(718) 398-3168
Mailing address
1480 PLEASANT VALLEY WAY, # 12, WEST ORANGE, NJ 07052-1300
(973) 687-6810
(973) 669-0032
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007923
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007923
STATE LICENSE NUMBER
NY
Enumeration date
08/11/2005
Last updated
07/08/2007
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