MEDICARE: JULIA IGDALEV DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DI20134	NJ

General Provider Information

NPI Number	:	1417950171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA IGDALEV DDS

Provider Business Mailing Address
First Line	:	1625 ANDERSON AVE
Second Line	:	STE 202
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2748
Country	:	US
Telephone Number	:	201-224-9444
Fax Number	:	201-224-9422

Provider Business Practice Location Address
First Line	:	1625 ANDERSON AVE
Second Line	:	STE 202
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2748
Country	:	US
Telephone Number	:	201-224-9444
Fax Number	:	201-224-9422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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