Basic Information
| Provider Information | |||||||||
| NPI: | 1669408639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIFFORD | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W MICHIGAN AVE | ||||||||
| Address2: | PO BOX 1123 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177876440 | ||||||||
| FaxNumber: | 5177874146 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 MADISON AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MOUNT HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080602055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092611660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 26NO09501300 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.