Provider Demographics
NPI:1477650463
Name:THE AURORA DE JULIIS, M.D. EUROPEAN MEDI SPA, LLC
Entity Type:Organization
Organization Name:THE AURORA DE JULIIS, M.D. EUROPEAN MEDI SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CARLUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-338-6300
Mailing Address - Street 1:1018 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2884
Mailing Address - Country:US
Mailing Address - Phone:973-338-6300
Mailing Address - Fax:973-338-5347
Practice Address - Street 1:1018 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2884
Practice Address - Country:US
Practice Address - Phone:973-338-6300
Practice Address - Fax:973-338-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04018600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06916Medicare UPIN
NJCA082600Medicare ID - Type Unspecified