Provider Demographics
NPI:1932139094
Name:TOKAZEWSKI, JEFFREY T (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:TOKAZEWSKI
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 1:63 N. LAKEVIEW DR
Mailing Address - Street 2:BLDG B, STE 201
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1026
Mailing Address - Country:US
Mailing Address - Phone:856-783-1777
Mailing Address - Fax:
Practice Address - Street 1:63 N. LAKEVIEW DR
Practice Address - Street 2:BLDG B, STE 201
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1026
Practice Address - Country:US
Practice Address - Phone:856-783-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8517606Medicaid
H38206Medicare UPIN
NJ8517606Medicaid