Provider Demographics
NPI:1992042329
Name:THEOHAROUS, JULIA M (L AC, DIPL AC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:THEOHAROUS
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1017
Mailing Address - Country:US
Mailing Address - Phone:973-769-7805
Mailing Address - Fax:
Practice Address - Street 1:1554 UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1357
Practice Address - Country:US
Practice Address - Phone:973-769-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00096400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist