Provider Demographics
NPI:1447524103
Name:JILL TOLIA MD LLC
Entity type:Organization
Organization Name:JILL TOLIA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-337-5939
Mailing Address - Street 1:5 ROOSEVELT PL
Mailing Address - Street 2:UNIT B1
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-6307
Mailing Address - Country:US
Mailing Address - Phone:973-337-5939
Mailing Address - Fax:
Practice Address - Street 1:5 ROOSEVELT PL
Practice Address - Street 2:UNIT B1
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-6307
Practice Address - Country:US
Practice Address - Phone:973-337-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09049200207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty