Provider Demographics
NPI:1114192101
Name:JULIANO, NICKOLAS DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:DANIEL
Last Name:JULIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:BENSLEY PAVILION
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-277-8700
Mailing Address - Fax:908-277-8993
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:BENSLEY PAVILION
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8700
Practice Address - Fax:908-277-8993
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09303500207RI0011X
ORMD28452207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR25928Medicaid
OR082165027OtherBCBS
OR25928Medicaid