Provider Demographics
NPI:1386770493
Name:HUBERT, JULIO ALEJANDRO
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ALEJANDRO
Last Name:HUBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7438
Mailing Address - Country:US
Mailing Address - Phone:908-687-6163
Mailing Address - Fax:
Practice Address - Street 1:20 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1420
Practice Address - Country:US
Practice Address - Phone:973-589-5841
Practice Address - Fax:973-589-8446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO48697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1142305Medicaid
450223Medicare ID - Type Unspecified
C55046Medicare UPIN