Basic Information
| Provider Information | |||||||||
| NPI: | 1689121857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDJOE | ||||||||
| FirstName: | MARCELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LB #7550 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191957550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 DUNHAMS CORNER RD | ||||||||
| Address2: | |||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088163500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322543300 | ||||||||
| FaxNumber: | 7326510822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2016 | ||||||||
| LastUpdateDate: | 02/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00496200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.