Healthcare Provider Details

I. General information

NPI: 1558636449
Provider Name (Legal Business Name): JULIUS A. MINGRONI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 GANTTOWN RD SUITE B4
SEWELL NJ
08080-2341
US

IV. Provider business mailing address

2 WINDING WAY
BERLIN NJ
08009-2250
US

V. Phone/Fax

Practice location:
  • Phone: 856-506-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB033504000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIUS A MINGRONI
Title or Position: SOLE MBR
Credential: MD
Phone: 484-557-8060