Provider Demographics
NPI:1730563560
Name:DEPIETRO, JULIANNE
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:DEPIETRO
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 1:1 GERMONDS VLG
Mailing Address - Street 2:APARTMENT 16
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1443
Mailing Address - Country:US
Mailing Address - Phone:845-825-0010
Mailing Address - Fax:
Practice Address - Street 1:1 GERMONDS VLG
Practice Address - Street 2:APARTMENT 16
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1443
Practice Address - Country:US
Practice Address - Phone:845-825-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019143-1225X00000X
NJ46TR00673600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist