Healthcare Provider Details

I. General information

NPI: 1184279572
Provider Name (Legal Business Name): JULIE YJ AN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 10TH ST
SECAUCUS NJ
07094-2921
US

IV. Provider business mailing address

140 MAYHILL ST APT 102
SADDLE BROOK NJ
07663-4668
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-3346
  • Fax:
Mailing address:
  • Phone: 201-509-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00942200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: