Provider Demographics
NPI:1912003765
Name:THOMAS, JODI (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:THOMAS
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:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-0313
Mailing Address - Country:US
Mailing Address - Phone:973-989-5270
Mailing Address - Fax:973-989-5274
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:973-989-5270
Practice Address - Fax:973-989-5274
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07295900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ005466Medicaid
NJI22294Medicare UPIN
NJ08625Medicare ID - Type Unspecified