Provider Demographics
NPI:1801927199
Name:MCCONNELL, JULIE W (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:W
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:W
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:185 ROUTE 36
Mailing Address - Street 2:STE 130
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1339
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-634-9647
Practice Address - Street 1:466 OLD HOOK ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-967-8221
Practice Address - Fax:201-634-9647
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57316207Q00000X
FLME87478207Q00000X
NJ25MA08278700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118950XGJMedicare PIN