Healthcare Provider Details

I. General information

NPI: 1770743957
Provider Name (Legal Business Name): JULIA ALEXANDRA SNYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MAIN ST STE 2
MOORESTOWN NJ
08057-3082
US

IV. Provider business mailing address

703 E MAIN ST STE 2
MOORESTOWN NJ
08057-3082
US

V. Phone/Fax

Practice location:
  • Phone: 856-415-6115
  • Fax:
Mailing address:
  • Phone: 856-415-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number435411
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10151900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: