Basic Information
| Provider Information | |||||||||
| NPI: | 1669748687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IAFRATE | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | LOUISA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 FT WASHINGTN AVE STE 199 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053535 | ||||||||
| FaxNumber: | 2123421470 | ||||||||
| Practice Location | |||||||||
| Address1: | 171 DELANCEY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100023411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9294552600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2012 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 107036 | MN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 56925 | MN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 288716 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | IA | MEDICAID | ENROLLED | 05 | MN | MEDICAID |