Provider Demographics
NPI:1477691095
Name:JULIAN SANSONE, DPM, PC
Entity Type:Organization
Organization Name:JULIAN SANSONE, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-771-6881
Mailing Address - Street 1:4 PEACOCK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5350
Mailing Address - Country:US
Mailing Address - Phone:732-771-6881
Mailing Address - Fax:
Practice Address - Street 1:4 PEACOCK LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-771-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00282700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02634742Medicaid
NJ0099198Medicaid
NYPJ6431Medicare ID - Type Unspecified
NY02634742Medicaid
NJ0099198Medicaid