Healthcare Provider Details

I. General information

NPI: 1649293986
Provider Name (Legal Business Name): WILLIAM JULIUS SJOVALL JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 LAKE AVE
FAIR HAVEN NJ
07704-3107
US

IV. Provider business mailing address

124 LAKE AVE
FAIR HAVEN NJ
07704-3107
US

V. Phone/Fax

Practice location:
  • Phone: 732-936-0077
  • Fax:
Mailing address:
  • Phone: 732-936-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB07113500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: