Provider Demographics
NPI:1083647887
Name:DESANCTIS, JULIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:T
Last Name:DESANCTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3674 ROUTE 27
Mailing Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A., DEPARTMENT B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-821-5563
Mailing Address - Fax:732-821-6675
Practice Address - Street 1:3674 ROUTE 27
Practice Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A., DEPARTMENT B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-821-5563
Practice Address - Fax:732-821-6675
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072303002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8843503Medicaid
NJG27260Medicare UPIN
NJ8843503Medicaid