Healthcare Provider Details

I. General information

NPI: 1245226794
Provider Name (Legal Business Name): JULIUS M GARDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN STREET F LEVEL
NEWARK NJ
07103
US

IV. Provider business mailing address

185 SOUTH ORANGE AVENUE MSB - I - 538
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-9000
  • Fax: 973-972-1681
Mailing address:
  • Phone: 973-972-3846
  • Fax: 973-972-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301032223
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08382400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: