Healthcare Provider Details

I. General information

NPI: 1417950171
Provider Name (Legal Business Name): JULIA IGDALEV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 ANDERSON AVE STE 202
FORT LEE NJ
07024-2748
US

IV. Provider business mailing address

1625 ANDERSON AVE STE 202
FORT LEE NJ
07024-2748
US

V. Phone/Fax

Practice location:
  • Phone: 201-224-9444
  • Fax: 201-224-9422
Mailing address:
  • Phone: 201-224-9444
  • Fax: 201-224-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI20134
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: