Provider Demographics
NPI:1124436639
Name:CRESPO, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CRESPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 NEPTUNE CT
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-5315
Mailing Address - Country:US
Mailing Address - Phone:732-966-0711
Mailing Address - Fax:609-693-5165
Practice Address - Street 1:1118 NEPTUNE CT
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-5315
Practice Address - Country:US
Practice Address - Phone:732-966-0711
Practice Address - Fax:609-693-5165
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ146D00000X, 171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No171WH0202XOther Service ProvidersContractorHome Modifications