Provider Demographics
NPI:1972886356
Name:SZABO, JULIANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:SZABO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:WHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:342 HAMBURG TPKE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2111
Mailing Address - Country:US
Mailing Address - Phone:973-595-7779
Mailing Address - Fax:973-904-3890
Practice Address - Street 1:342 HAMBURG TPKE.
Practice Address - Street 2:SUITE 205
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2111
Practice Address - Country:US
Practice Address - Phone:973-595-7779
Practice Address - Fax:973-904-3890
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00326400363A00000X
PAMA055118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50105553OtherCAPITAL BLUE CROSS
PA234246J67Medicare PIN