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General NPI Number Information
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NPI Number | 1679958987
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Entity Type | Individual
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Provider Name | JUDY MARCEL THOMAS NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 312 S ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2502
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Country | US
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Telephone | 973-532-7898
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Fax | 973-821-5999
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Provider Business Mailing Address
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Address Line | PO BOX 5582
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City | SOMERSET
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State | NJ
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Zip | 08875-5582
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Country | US
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Telephone | 908-239-6742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00514200
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License Number State | NJ
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