Provider Demographics
NPI:1275643116
Name:MARESSA, JULIAN MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:MARK
Last Name:MARESSA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:181 W WHITE HORSE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-3234
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-05-25
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Provider Licenses
StateLicense IDTaxonomies
NJMB055641207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5321204Medicaid
NJF44273Medicare UPIN
163526SK3Medicare PIN
NJ5321204Medicaid