Basic Information
| Provider Information | |||||||||
| NPI: | 1659374023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZUMIGALA | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FARKASH-SZUMIGALA | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 240 RED TAIL | ||||||||
| Address2: | STE 5&6 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166770454 | ||||||||
| FaxNumber: | 7167120061 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 RED TAIL | ||||||||
| Address2: | STE 5&6 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166770454 | ||||||||
| FaxNumber: | 7167120061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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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 | 207V00000X | 2111921-1 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 02157995 | 05 | NY | MEDICAID |