Basic Information
Provider Information | |||||||||
NPI: | 1154335834 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ELSIGAN | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ELSIGAN | ||||||||
OtherFirstName: | JULIE | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | P.A. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 135 N UNION ST | ||||||||
Address2: | BLUE BIRD SQUARE | ||||||||
City: | OLEAN | ||||||||
State: | NY | ||||||||
PostalCode: | 147602736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7163757500 | ||||||||
FaxNumber: | 7167016853 | ||||||||
Practice Location | |||||||||
Address1: | 135 N UNION ST | ||||||||
Address2: | BLUE BIRD SQUARE | ||||||||
City: | OLEAN | ||||||||
State: | NY | ||||||||
PostalCode: | 147602736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7163757500 | ||||||||
FaxNumber: | 7167016853 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2006 | ||||||||
LastUpdateDate: | 09/02/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 005893 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
ID | Type | State | Issuer | Description | 000000196648 | 01 | NY | UNIVERA | OTHER | 000570389005 | 01 |   | BC/BS | OTHER | 9512015 | 01 |   | INDEPENDENT HEALTH | OTHER |