Individual
JULIE THOMAS KIDANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1310 BROAD ST, BLOOMFIELD, NJ 07003-3010
(973) 338-0935
(973) 338-1097
Mailing address
PO BOX 419430, BOSTON, MA 02241-9430
(201) 666-3900
(201) 261-0505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB09393100
NJ
Other
Enumeration date
06/17/2010
Last updated
04/25/2017
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