MEDICARE: DR. CHERRYL L THOMAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA05345200	NJ
2	207R00000X	Internal Medicine Physician	25MA05345200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19126	OTHER	NJ	UNIVERSITY HEALTH PLANS
2	5084649	OTHER	NJ	AETNA#
3	0404769000	OTHER	NJ	AMERIHEALTH#
4	210751	OTHER	NJ	UNIFORMED SERVICES FHP#
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2069923	OTHER	NJ	AETNA (HMO)(CAPITATED)#
7	223586872	OTHER	NJ	TAX ID#
8	OK9320	OTHER	NJ	HEALTH NET#
9	P1078964	OTHER	NJ	OXFORD#
10	110230391	OTHER	NJ	RR MDCR #
11	2598310	OTHER	NJ	GHI (PPO)#
12	37N381	OTHER	NJ	BC/BS NY(HMO/PPO/EPO/POS

General Provider Information

NPI Number	:	1134113640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERRYL L THOMAS MD

Provider Business Mailing Address
First Line	:	PO BOX 58
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-0058
Country	:	US
Telephone Number	:	732-658-1375
Fax Number	:	732-658-1376

Provider Business Practice Location Address
First Line	:	18 CENTRE DR. SUITE 205
Second Line	:
City	:	MONROE TWP
State	:	NJ
Zip	:	08831
Country	:	US
Telephone Number	:	732-658-1375
Fax Number	:	732-658-1376

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	01/04/2022

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