Provider Demographics
NPI:1962747501
Name:DIDDELL, JULIA M (LPO, BOCO, BOCP)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:M
Last Name:DIDDELL
Suffix:
Gender:F
Credentials:LPO, BOCO, BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROSPECT ST
Mailing Address - Street 2:C/O ORTHO CARE, INC
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2114
Mailing Address - Country:US
Mailing Address - Phone:908-232-9910
Mailing Address - Fax:908-232-9915
Practice Address - Street 1:10 PROSPECT ST
Practice Address - Street 2:C/O ORTHO CARE, INC
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2114
Practice Address - Country:US
Practice Address - Phone:908-232-9910
Practice Address - Fax:908-232-9915
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00014100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0244376Medicaid
NJ223445698OtherHORIZON
NJ223445698OtherHORIZON