Provider Demographics
NPI:1699713404
Name:PIEPSZAK, THOMAS DONALD (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DONALD
Last Name:PIEPSZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CRUSHER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-2204
Mailing Address - Country:US
Mailing Address - Phone:609-466-9204
Mailing Address - Fax:
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2827
Practice Address - Country:US
Practice Address - Phone:609-737-1116
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03346000207Q00000X
PAOS003734L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
124790Medicare ID - Type Unspecified
NJE79632Medicare UPIN