Active NPI
Julliana Jean-Mary, PA
- Physician Assistant
- Syracuse, NY
National Provider Identifier
1013545896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1419 Salt Springs Rd
Syracuse, NY 13214-1302 - Phone
- (315) 445-4745
- NPI assigned
- Mar 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1419 Salt Springs Rd
Syracuse, NY 13214-1302
Mailing address
1419 Salt Springs Rd
Syracuse, NY 13214-1302
Phone (315) 445-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025902 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icahn School of Medicine at Mount Sinai | Current | Accepting new patients | |
| Icahn School of Medicine at Mount Sinai | Current | Accepting new patients | |
| Fpa Hospital Based | Current | Accepting new patients |
Locations
2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245
5 E 98th St
New York, NY 10029
Phone (212) 241-3986
150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119
1000 10th Ave
New York, NY 10019
Phone (212) 523-2369
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- New York, NY
- NPI 1841531795
-
- Emergency Medicine Physician
- New York, NY
- NPI 1346908662
-
- Eyewear Supplier
- New York, NY
- NPI 1760227466
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605744000000",
"number": "1013545896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1419 SALT SPRINGS RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132141302",
"telephone_number": "315-445-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1419 SALT SPRINGS RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132141302",
"telephone_number": "315-445-4745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEAN-MARY",
"first_name": "JULLIANA",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-29",
"last_updated": "2020-11-19",
"certification_date": "2020-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.