Provider Demographics
NPI:1174614879
Name:LAIFER, JULIE LAUREN (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LAUREN
Last Name:LAIFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LAUREN
Other - Last Name:GLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27 SPRITEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-454-4818
Mailing Address - Fax:
Practice Address - Street 1:2600 POST RD
Practice Address - Street 2:SUITE 1L
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1258
Practice Address - Country:US
Practice Address - Phone:203-254-3886
Practice Address - Fax:203-254-3472
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035758207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001357584Medicaid
160001938Medicare ID - Type Unspecified
CT001357584Medicaid