Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Tibu Raju Thomas

Individual provider Adult Health Nurse Practitioner · NPI 1972375996

Mr. Tibu Raju Thomas is a Nurse Practitioner in Montvale, New Jersey. Qualified in 2023, 3 years ago. Practices with MSK Bergen, a 254-clinician group and accepts Medicare assignment. Licensed in New Jersey and New York.

Years since qualifying
3
Licensed in
NJ, NY
In the registry since
2023
Specialties on file
2

Practice location Address checks out

225 Summit Ave
Montvale, NJ 07645-1523
Phone: (201) 472-5431
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 26NJ14954700 (NJ)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 311660 (NY)

Record details

NPI number1972375996
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 24, 2023
Last updated in NPPESSeptember 11, 2024
Certification dateSeptember 11, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Msk Bergen — 254 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Montvale