Healthcare Provider Details

I. General information

NPI: 1265356984
Provider Name (Legal Business Name): JULIA FLORENCE PENNELLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHLAND AVE STE 100B
GLEN RIDGE NJ
07028-1521
US

IV. Provider business mailing address

271 GROVE AVE STE A
VERONA NJ
07044-1731
US

V. Phone/Fax

Practice location:
  • Phone: 973-969-3800
  • Fax:
Mailing address:
  • Phone: 973-969-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01041800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: