Healthcare Provider Details

I. General information

NPI: 1154583904
Provider Name (Legal Business Name): THOMAS SCUDERI MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HAZLET AVE SUITE 10
HAZLET NJ
07730-1623
US

IV. Provider business mailing address

80 HAZLET AVE SUITE 10
HAZLET NJ
07730-1623
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-0400
  • Fax: 732-264-1149
Mailing address:
  • Phone: 732-264-0400
  • Fax: 732-264-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA02982800
License Number StateNJ

VIII. Authorized Official

Name: THOMAS SCUDERI
Title or Position: OWNER
Credential: MD
Phone: 732-264-0400