Provider Demographics
NPI:1871516245
Name:SUGAR-ROSA, JULIE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:SUGAR-ROSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-0085
Mailing Address - Country:US
Mailing Address - Phone:973-209-6090
Mailing Address - Fax:973-298-6084
Practice Address - Street 1:3339 ROUTE 94
Practice Address - Street 2:
Practice Address - City:HARDYSTON
Practice Address - State:NJ
Practice Address - Zip Code:07419
Practice Address - Country:US
Practice Address - Phone:973-209-6090
Practice Address - Fax:973-298-6084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00475500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64551Medicare UPIN
NJSU446247Medicare ID - Type Unspecified