Healthcare Provider Details

I. General information

NPI: 1134113640
Provider Name (Legal Business Name): CHERRYL L THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/04/2022
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CENTRE DR. SUITE 205
MONROE TWP NJ
08831
US

IV. Provider business mailing address

PO BOX 58
FRANKLIN PARK NJ
08823-0058
US

V. Phone/Fax

Practice location:
  • Phone: 732-658-1375
  • Fax: 732-658-1376
Mailing address:
  • Phone: 732-658-1375
  • Fax: 732-658-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05345200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05345200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: