Provider Demographics
NPI:1962407221
Name:STEFFE, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:STEFFE
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 1:1007 MANTUA PIKE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3963
Mailing Address - Country:US
Mailing Address - Phone:856-256-7705
Mailing Address - Fax:856-256-7709
Practice Address - Street 1:1007 MANTUA PIKE, SUITE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3963
Practice Address - Country:US
Practice Address - Phone:856-256-7705
Practice Address - Fax:856-256-7709
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06506200208200000X
PAMD046057L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7403402Medicaid
NJ042493SYMOtherMEDICARE PROVIDER ID
PA848743STKOtherMEDICARE PROVIDER ID
NJ042493SYMOtherMEDICARE PROVIDER ID