Healthcare Provider Details

I. General information

NPI: 1427254721
Provider Name (Legal Business Name): JUDITH MARIE UGALE-WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH MARIE KATIGBAK UGALE MD

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7550
  • Fax: 973-290-7364
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301082671
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2012-01473
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number30561
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA11329100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: