Provider Demographics
NPI:1487496428
Name:CHISLOM, TOBIAS F JR (DR)
Entity type:Individual
Prefix:
First Name:TOBIAS
Middle Name:F
Last Name:CHISLOM
Suffix:JR
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 VICK AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-3276
Mailing Address - Country:US
Mailing Address - Phone:609-231-4596
Mailing Address - Fax:
Practice Address - Street 1:591 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2369
Practice Address - Country:US
Practice Address - Phone:609-463-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02249300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist