Provider Demographics
NPI:1275893794
Name:FRU, NJI JULIUS
Entity Type:Individual
Prefix:MR
First Name:NJI
Middle Name:JULIUS
Last Name:FRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17505 MADRILLON WAY
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3457
Mailing Address - Country:US
Mailing Address - Phone:301-675-1652
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 408
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2818
Practice Address - Country:US
Practice Address - Phone:301-675-1652
Practice Address - Fax:240-607-8461
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1028060363LF0000X, 363LP0808X
MDR203089363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health