Provider Demographics
NPI:1558636449
Name:JULIUS A. MINGRONI, LLC
Entity Type:Organization
Organization Name:JULIUS A. MINGRONI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MINGRONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-557-8060
Mailing Address - Street 1:2 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:438 GANTTOWN RD
Practice Address - Street 2:SUITE B4
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2341
Practice Address - Country:US
Practice Address - Phone:856-506-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB033504000207Q00000X
208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ160070YG7QMedicare PIN