Provider Demographics
NPI:1922046630
Name:LIGHTFOOT, JUDITH ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD STE 3100-C
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7070
Mailing Address - Fax:856-566-6906
Practice Address - Street 1:42 E LAUREL RD STE 3100-C
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7070
Practice Address - Fax:856-566-6906
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB66998207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7612508Medicaid
NJ440002295OtherRAILROAD MEDICARE
NJ440002295OtherRAILROAD MEDICARE
NJ011861ZGH1Medicare PIN
NJ7612508Medicaid