Healthcare Provider Details

I. General information

NPI: 1184067332
Provider Name (Legal Business Name): JULIA FOXWORTH MCMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WASHINGTON VALLEY RD STE 207
WARREN NJ
07059-7177
US

IV. Provider business mailing address

161 WASHINGTON VALLEY RD STE 207
WARREN NJ
07059-7177
US

V. Phone/Fax

Practice location:
  • Phone: 908-378-8878
  • Fax: 630-487-2411
Mailing address:
  • Phone: 908-378-8878
  • Fax: 630-487-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5078
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51966
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5078
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5403
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00677000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: