Provider Demographics
NPI:1194921098
Name:RANDOLPH, JUDITH G (MSN ARNP RN BC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MSN ARNP RN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 E ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225
Mailing Address - Country:US
Mailing Address - Phone:609-645-2713
Mailing Address - Fax:609-407-7149
Practice Address - Street 1:3205 FIRE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5857
Practice Address - Country:US
Practice Address - Phone:609-407-1220
Practice Address - Fax:609-407-7149
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06349500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q18719Medicare UPIN
NJ080577AUBMedicare ID - Type Unspecified