Provider Demographics
NPI:1265554117
Name:WITHERIDGE, ANN MARIE (APN,C)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:WITHERIDGE
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ZIRKEL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5713
Mailing Address - Country:US
Mailing Address - Phone:732-594-0704
Mailing Address - Fax:732-594-3548
Practice Address - Street 1:126 E. LINCOLN AVE, MERCK & CO., POB 2000
Practice Address - Street 2:RY 59-10
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-594-0704
Practice Address - Fax:732-594-3548
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00084700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0085243Medicaid
NJ094064UKJMedicare ID - Type Unspecified
NJQ51541Medicare UPIN