Healthcare Provider Details

I. General information

NPI: 1952739625
Provider Name (Legal Business Name): JUSTIN BRIAN JIULIANTI DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W ROUTE 70
MARLTON NJ
08053-1635
US

IV. Provider business mailing address

315 W ROUTE 70
MARLTON NJ
08053-1635
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-5501
  • Fax:
Mailing address:
  • Phone: 856-596-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number29VI00637800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: