Provider Demographics
NPI:1730178054
Name:RITSAN, JULIA B (DO)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:B
Last Name:RITSAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748
Mailing Address - Country:US
Mailing Address - Phone:732-615-3900
Mailing Address - Fax:732-615-0865
Practice Address - Street 1:1270 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748
Practice Address - Country:US
Practice Address - Phone:732-615-3900
Practice Address - Fax:732-615-0185
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07926900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096510OtherMEDICARE
NJ096510OtherMEDICARE
NJI46652Medicare UPIN