Provider Demographics
NPI:1114683877
Name:THOMAS, JANELLE (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE RD STE E5
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5052
Mailing Address - Country:US
Mailing Address - Phone:732-230-2661
Mailing Address - Fax:732-383-8149
Practice Address - Street 1:9 MULE RD STE E5
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5052
Practice Address - Country:US
Practice Address - Phone:732-230-2661
Practice Address - Fax:732-383-8149
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00656900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant