MEDICARE: JULIANNE W CHILDS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	MB052916	NJ

General Provider Information

NPI Number	:	1639166101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE W CHILDS D.O.

Provider Business Mailing Address
First Line	:	210 S SHORE RD
Second Line	:	SUITE 106
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Provider Business Practice Location Address
First Line	:	210 S SHORE RD
Second Line	:	SUITE 106
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/10/2011

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