Provider Demographics
NPI:1033303458
Name:PANTELICK, JULIE M (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:PANTELICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 HAMILTON AVE
Mailing Address - Street 2:SUITE #B158
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1915
Mailing Address - Country:US
Mailing Address - Phone:609-599-5139
Mailing Address - Fax:609-599-5047
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:SUITE #B158
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5139
Practice Address - Fax:609-599-5047
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT032.0070371208M00000X
NJ25MB09174400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018721Medicaid
VT1018721Medicaid