Provider Demographics
NPI:1679777981
Name:IULA, KEVIN J (OTR)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:IULA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 UNDERCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1623
Mailing Address - Country:US
Mailing Address - Phone:845-893-9324
Mailing Address - Fax:
Practice Address - Street 1:77 E 43RD ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1116
Practice Address - Country:US
Practice Address - Phone:845-893-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00364600171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor