Provider Demographics
NPI:1316046824
Name:BEAUCHAMP, JEFFREY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:BEAUCHAMP
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 1:1600 SAINT GEORGES AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2764
Mailing Address - Country:US
Mailing Address - Phone:732-381-0121
Mailing Address - Fax:732-381-1561
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-381-0121
Practice Address - Fax:732-381-1561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06005600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBE786126Medicaid
NJG09502Medicare UPIN