Provider Demographics
NPI:1649556903
Name:CARDONICK, JULIE BETH (IBCLC, CD (DONA))
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:BETH
Last Name:CARDONICK
Suffix:
Gender:F
Credentials:IBCLC, CD (DONA)
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:CARDONICK
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC, CD (DONA)
Mailing Address - Street 1:991 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5511
Mailing Address - Country:US
Mailing Address - Phone:201-837-5910
Mailing Address - Fax:
Practice Address - Street 1:991 RICHARD CT
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5511
Practice Address - Country:US
Practice Address - Phone:201-837-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ107-26311174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula