Provider Demographics
NPI:1528028313
Name:GERARDIS, JUDI R (MD)
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:R
Last Name:GERARDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:551-996-1235
Mailing Address - Fax:551-996-0469
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-3464
Practice Address - Fax:201-487-0232
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA66371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ160059349OtherRAILROAD MEDICARE#
NJP677956OtherOXFORD#
NJ0980221OtherAETNA HMO#
NJ50Z731OtherEMPIRE BCBS#
NJ5710263OtherGHI PPO#
NJ0K9231OtherHEALTHNET#
NJ5217583OtherAETNA PPO#
NJ0K9231OtherHEALTHNET#
NJ001723BHWMedicare PIN