Provider Demographics
NPI:1285790782
Name:DEBLASIO, THOMAS FRANK (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRANK
Last Name:DEBLASIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 CORLIES AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5197
Mailing Address - Country:US
Mailing Address - Phone:732-774-2336
Mailing Address - Fax:732-774-2337
Practice Address - Street 1:1944 CORLIES AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-5197
Practice Address - Country:US
Practice Address - Phone:732-774-2336
Practice Address - Fax:732-774-2337
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05815100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE723685Medicare ID - Type Unspecified
NJF28003Medicare UPIN