Healthcare Provider Details

I. General information

NPI: 1235391673
Provider Name (Legal Business Name): JULIE MARIE SANICOLA-JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 12/21/2025
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ANN ST #N304
CLIFTON NJ
07013-2143
US

IV. Provider business mailing address

2 ANN ST #N304
CLIFTON NJ
07013-2143
US

V. Phone/Fax

Practice location:
  • Phone: 240-217-2182
  • Fax:
Mailing address:
  • Phone: 240-217-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH78985
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: