Provider Demographics
NPI:1841223534
Name:ENDAYA-AGUILA, THELMA (MD)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:ENDAYA-AGUILA
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 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-963-2320
Mailing Address - Fax:201-222-2099
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-963-2320
Practice Address - Fax:201-222-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA3538200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1108107Medicaid
F58362Medicare UPIN