Provider Demographics
NPI:1992825442
Name:SIMSER, JULIE ELLEN (CA LAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLEN
Last Name:SIMSER
Suffix:
Gender:F
Credentials:CA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 RIVER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3361
Mailing Address - Country:US
Mailing Address - Phone:732-758-1234
Mailing Address - Fax:
Practice Address - Street 1:740 RIVER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3361
Practice Address - Country:US
Practice Address - Phone:732-758-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00040200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist