Provider Demographics
NPI:1205080777
Name:AGRANOVICH, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:AGRANOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 OCEAN AVE
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3270
Mailing Address - Country:US
Mailing Address - Phone:917-771-8378
Mailing Address - Fax:718-233-6335
Practice Address - Street 1:2900 OCEAN AVE
Practice Address - Street 2:SUITE 1-E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3270
Practice Address - Country:US
Practice Address - Phone:917-771-8378
Practice Address - Fax:718-233-6335
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011849-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist