Healthcare Provider Details

I. General information

NPI: 1538474408
Provider Name (Legal Business Name): JERRY THOMAS MD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134-6 FRANKLIN CORNER ROAD
LAWRENCEVILLE NJ
08648-5246
US

IV. Provider business mailing address

800 DENOW RD SUITE 382
PENNINGTON NJ
08534-5246
US

V. Phone/Fax

Practice location:
  • Phone: 609-662-1900
  • Fax: 609-662-1901
Mailing address:
  • Phone: 609-613-2226
  • Fax: 609-662-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE MIGLIACCIO
Title or Position: BILLING MANAGER
Credential:
Phone: 606-613-2226