Provider Demographics
NPI:1679634778
Name:THALODY, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:THALODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLIAMSON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3672
Mailing Address - Country:US
Mailing Address - Phone:908-352-0560
Mailing Address - Fax:908-352-4066
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:STE 400
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3672
Practice Address - Country:US
Practice Address - Phone:908-352-0560
Practice Address - Fax:908-352-4066
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34780207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1146602Medicaid
NJC53005Medicare UPIN
NJ1146602Medicaid