Basic Information
| Provider Information | |||||||||
| NPI: | 1194814004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACIEJEWSKI | ||||||||
| FirstName: | JULIANE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922832 | ||||||||
| FaxNumber: | 7168816247 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922832 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 235904 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02661425 | 05 | NY | MEDICAID |