Healthcare Provider Details

I. General information

NPI: 1194870816
Provider Name (Legal Business Name): JUDITH M. KERN APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DRIVE SUITE 12
TOMS RIVER NJ
08755-8054
US

IV. Provider business mailing address

20 HOSPITAL DR SUITE 12
TOMS RIVER NJ
08755-6434
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-2299
  • Fax: 732-244-5757
Mailing address:
  • Phone: 732-244-2299
  • Fax: 732-244-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN04459600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number26NC04459600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: