Provider Demographics
NPI:1295771335
Name:ELIZONDO, JULIA A (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:A
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 48310
Mailing Address - Street 2:EMERGENCY PHYSICIANS OF EMA INC
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4810
Mailing Address - Country:US
Mailing Address - Phone:201-894-3450
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:ENGLEWOOD HOSPITAL
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-984-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00130000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086990Medicare ID - Type Unspecified
Q32503Medicare UPIN