Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MB055641 | NJ |
NPI | 1275643116 |
---|---|
Provider Name | Dr. Julian Mark Maressa |
First Address | Marlton, NJ 08053-4112 |
Second Address | Berlin, NJ 08009-2032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 25/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5321204 | (05) | NJ |
F44273 | (02) | NJ |