Provider Demographics
NPI:1245226794
Name:GARDIN, JULIUS M (MD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:M
Last Name:GARDIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:185 SOUTH ORANGE AVENUE
Mailing Address - Street 2:MSB - I - 538
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-3846
Mailing Address - Fax:973-972-8927
Practice Address - Street 1:140 BERGEN STREET
Practice Address - Street 2:F LEVEL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-9000
Practice Address - Fax:973-972-1681
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032223207RC0000X
NJ25MA08382400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4431820Medicaid
A48482Medicare UPIN
M71670Medicare UPIN