1528028313 NPI number — JUDI R GERARDIS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528028313 NPI number — JUDI R GERARDIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERARDIS
Provider First Name:
JUDI
Provider Middle Name:
R
Provider Name Prefix Text:
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:
1528028313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PROSPECT AVE
Provider Second Line Business Mailing Address:
SUITE 607
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
551-996-1235
Provider Business Mailing Address Fax Number:
551-996-0469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 607
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-487-3464
Provider Business Practice Location Address Fax Number:
201-487-0232
Provider Enumeration Date:
03/24/2006

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: 207V00000X , with the licence number:  MA66371 , 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: 160059349 . This is a "RAILROAD MEDICARE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P677956 . This is a "OXFORD#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0980221 . This is a "AETNA HMO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 50Z731 . This is a "EMPIRE BCBS#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5710263 . This is a "GHI PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0K9231 . This is a "HEALTHNET#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5217583 . This is a "AETNA PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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