Provider Demographics
NPI:1245422740
Name:THOMAS, ANITA (DNP, ANP-BC, CWS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DNP, ANP-BC, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 HEBBERD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4452
Mailing Address - Country:US
Mailing Address - Phone:201-572-8136
Mailing Address - Fax:
Practice Address - Street 1:647 MAIN AVE STE 207
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4962
Practice Address - Country:US
Practice Address - Phone:973-735-1231
Practice Address - Fax:973-735-1232
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00133100363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0232980Medicaid
NJ116931V07Medicare PIN
NJ0232980Medicaid