Provider Demographics
NPI:1447693049
Name:ENDRIZZI, JULIE IRIS (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:IRIS
Last Name:ENDRIZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:EMERGENCY CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7075
Mailing Address - Fax:585-723-7899
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:EMERGENCY CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7075
Practice Address - Fax:585-723-7899
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283267207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04464522Medicaid
NYJ400314790-GRP70008AMedicare PIN
NYJ400314799-GRPBA0017Medicare PIN