Healthcare Provider Details

I. General information

NPI: 1336821586
Provider Name (Legal Business Name): JULIA ELIZABETH FRESOLONE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA ELIZABETH CLARK

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MADISON AVE
MORRISTOWN NJ
07960-6092
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-1010
  • Fax: 973-267-5521
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ14891600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ14891600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: