Basic Information
Provider Information
NPI: 1205434727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTSCH
FirstName: JULIA
MiddleName: LOREN
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1555 LONG POND RD
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146264164
CountryCode: US
TelephoneNumber: 5857237225
FaxNumber:  
Practice Location
Address1: 1555 LONG POND RD
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146264164
CountryCode: US
TelephoneNumber: 5857237225
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2020
LastUpdateDate: 08/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X025697NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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