1134113640 NPI number — DR. CHERRYL L THOMAS MD

Table of content: DR. CHERRYL L THOMAS MD (NPI 1134113640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134113640 NPI number — DR. CHERRYL L THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
CHERRYL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134113640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 CENTRE DR. SUITE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE TWP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-658-1375
Provider Business Practice Location Address Fax Number:
732-658-1376
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA05345200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MA05345200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19126 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5084649 . This is a "AETNA#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0404769000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 210751 . This is a "UNIFORMED SERVICES FHP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3610209 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2069923 . This is a "AETNA (HMO)(CAPITATED)#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223586872 . This is a "TAX ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK9320 . This is a "HEALTH NET#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1078964 . This is a "OXFORD#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110230391 . This is a "RR MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2598310 . This is a "GHI (PPO)#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 37N381 . This is a "BC/BS NY(HMO/PPO/EPO/POS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com