Provider Demographics
NPI:1477616498
Name:GENOVA, JUDITH LYNN (APN, C)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNN
Last Name:GENOVA
Suffix:
Gender:F
Credentials:APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 POND RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5780
Mailing Address - Country:US
Mailing Address - Phone:609-926-3850
Mailing Address - Fax:
Practice Address - Street 1:2106 NEW RD STE F2
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1053
Practice Address - Country:US
Practice Address - Phone:609-469-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00013500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070561NTZMedicare ID - Type Unspecified
NJP91725Medicare UPIN