Provider Demographics
NPI:1346232964
Name:HUGH-GOFFE, JUDITH C (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:HUGH-GOFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2103
Mailing Address - Country:US
Mailing Address - Phone:973-732-1718
Mailing Address - Fax:973-732-1719
Practice Address - Street 1:120 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2103
Practice Address - Country:US
Practice Address - Phone:973-732-1718
Practice Address - Fax:973-732-1719
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07567100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056235Medicaid
NJ100252VAEMedicare PIN
NJ0056235Medicaid