Healthcare Provider Details

I. General information

NPI: 1366446387
Provider Name (Legal Business Name): JULIUS E BLIACH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 BERGENLINE AVE
WEST NEW YORK NJ
07093-5524
US

IV. Provider business mailing address

4 ENDICOTT LN
WEST WINDSOR NJ
08550-2910
US

V. Phone/Fax

Practice location:
  • Phone: 609-799-2924
  • Fax: 201-866-8254
Mailing address:
  • Phone: 609-799-2924
  • Fax: 201-866-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01902600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037355-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: