Provider Demographics
NPI:1720034184
Name:JULIO H URENA MD PA
Entity Type:Organization
Organization Name:JULIO H URENA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:H
Authorized Official - Last Name:URENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-574-0010
Mailing Address - Street 1:40 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2219
Mailing Address - Country:US
Mailing Address - Phone:973-574-0010
Mailing Address - Fax:
Practice Address - Street 1:40 UNION AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2219
Practice Address - Country:US
Practice Address - Phone:973-574-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6048102Medicaid
NJ6048102Medicaid