Provider Demographics
NPI:1427152875
Name:STEPHEN THOMSEN MD PA
Entity type:Organization
Organization Name:STEPHEN THOMSEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-866-3322
Mailing Address - Street 1:510 31ST STREET
Mailing Address - Street 2:BASEMENT
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-866-3322
Mailing Address - Fax:201-866-2289
Practice Address - Street 1:510 31ST STREET
Practice Address - Street 2:BASEMENT
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-866-3322
Practice Address - Fax:201-866-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071234Medicare ID - Type Unspecified