Provider Demographics
NPI:1568791960
Name:GANG, JUDITH (FNP)
Entity type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:
Last Name:GANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PALISADE AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:917-539-1804
Mailing Address - Fax:201-792-7812
Practice Address - Street 1:142 PALISADE AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:917-539-1804
Practice Address - Fax:201-792-7812
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00582300363LF0000X
NYF335304-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03208995Medicaid
NYA400088683Medicare PIN