Provider Demographics
NPI:1285611426
Name:RICH, THOMAS R (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:RICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1540
Mailing Address - Country:US
Mailing Address - Phone:732-531-0320
Mailing Address - Fax:732-531-2274
Practice Address - Street 1:215 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1540
Practice Address - Country:US
Practice Address - Phone:732-531-0320
Practice Address - Fax:732-531-2274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1705213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45087Medicare UPIN
NJRI728942Medicare ID - Type Unspecified