Provider Demographics
NPI:1710042494
Name:GERMAINE, JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:
Last Name:GERMAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDE
Other - Middle Name:
Other - Last Name:GERMAINE-MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1084 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1202
Mailing Address - Country:US
Mailing Address - Phone:860-879-9360
Mailing Address - Fax:
Practice Address - Street 1:493 RINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865-4820
Practice Address - Country:US
Practice Address - Phone:860-879-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51302207Q00000X
NJ25MA05177600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA05177600OtherLICENSE
10701768OtherCAQH ID
NJ1710042494OtherNPI
NJFG3572650OtherDEA
NJ176791C2FMedicare UPIN