Provider Demographics
NPI:1053405001
Name:JULIANA KANJI PSYCHIATRIC SERVICES, PC
Entity type:Organization
Organization Name:JULIANA KANJI PSYCHIATRIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-727-1100
Mailing Address - Street 1:775 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-427-1100
Mailing Address - Fax:631-784-7748
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-427-1100
Practice Address - Fax:631-784-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01393099Medicaid
NYBK2410948OtherDEA LICENSE
NY01393099Medicaid
NYF47465Medicare UPIN
NY77K001Medicare ID - Type Unspecified