1336199207 NPI number — DR. MANEESH JULKA DDS

Table of content: DR. MANEESH JULKA DDS (NPI 1336199207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336199207 NPI number — DR. MANEESH JULKA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JULKA
Provider First Name:
MANEESH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336199207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 WEAVER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-709-3963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S. WHITE HORSE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDENWOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-566-7466
Provider Business Practice Location Address Fax Number:
856-566-9161
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2223100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0070777 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".