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General NPI Number Information
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NPI Number | 1770651424
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Entity Type | Individual
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Provider Name | JULIANE IANNUZZI PAC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 90 MILLBURN AVE SUITE 204
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City | MILLBURN
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State | NJ
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Zip | 07041
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Country | US
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Telephone | 973-484-6239
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Fax | 973-484-6804
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | SUMMIT
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State | NJ
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Zip | 07901
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Country | US
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Telephone | 973-484-6239
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Fax | 973-484-6804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MP471
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License Number State | NJ
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