1427254721 NPI number — DR. JUDITH MARIE UGALE-WILSON MD

Table of content: DR. JUDITH MARIE UGALE-WILSON MD (NPI 1427254721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427254721 NPI number — DR. JUDITH MARIE UGALE-WILSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGALE-WILSON
Provider First Name:
JUDITH
Provider Middle Name:
MARIE
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:
UGALE
Provider Other First Name:
JUDITH MARIE
Provider Other Middle Name:
KATIGBAK
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427254721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-362-1735
Provider Business Mailing Address Fax Number:
973-290-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-6136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-971-7550
Provider Business Practice Location Address Fax Number:
973-290-7364
Provider Enumeration Date:
06/23/2007

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: 208000000X , with the licence number:  4301082671 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: 2012-01473 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: 30561 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: 25MA11329100 , 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: 1427254721 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18500 . This is a "EVOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9303224 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5909275 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA26508552 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20077595 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 045 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 206995 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1844D . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 305618 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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