Provider Demographics
NPI:1679958987
Name:THOMAS, JUDY MARCEL (NP-C)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:MARCEL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5582
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08875-5582
Mailing Address - Country:US
Mailing Address - Phone:908-239-6742
Mailing Address - Fax:
Practice Address - Street 1:312 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2502
Practice Address - Country:US
Practice Address - Phone:973-532-7898
Practice Address - Fax:973-821-5999
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00514200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily