Provider Demographics
NPI:1174525976
Name:GUTMAN, JULIUS (MD FACC)
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2629
Mailing Address - Country:US
Mailing Address - Phone:973-746-8585
Mailing Address - Fax:973-746-0088
Practice Address - Street 1:62 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2629
Practice Address - Country:US
Practice Address - Phone:973-746-8585
Practice Address - Fax:973-746-0088
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51072207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ551575OtherMEDICARE ID TYPE UNSPECIFIED
NJ551575OtherMEDICARE ID TYPE UNSPECIFIED