Provider Demographics
NPI:1649293986
Name:SJOVALL, WILLIAM JULIUS JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JULIUS
Last Name:SJOVALL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3107
Mailing Address - Country:US
Mailing Address - Phone:732-936-0077
Mailing Address - Fax:
Practice Address - Street 1:124 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3107
Practice Address - Country:US
Practice Address - Phone:732-936-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07113500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ045498MHJMedicare ID - Type Unspecified
NJH31628Medicare UPIN