Provider Demographics
NPI:1992274864
Name:DEANGELISLASCHEID, MARIA JULIA (DAC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JULIA
Last Name:DEANGELISLASCHEID
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2517
Mailing Address - Country:US
Mailing Address - Phone:609-334-1352
Mailing Address - Fax:
Practice Address - Street 1:6717 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2621
Practice Address - Country:US
Practice Address - Phone:609-551-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00124800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist