Provider Demographics
NPI:1992733760
Name:THOMSEN, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:THOMSEN
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 1:510 31ST STREET
Mailing Address - Street 2:BASEMENT
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3907
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:07087-3907
Practice Address - Country:US
Practice Address - Phone:201-866-3322
Practice Address - Fax:201-866-2289
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035990207RN0300X
ME009777207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3142701Medicaid
NJ080270RWRMedicare ID - Type Unspecified
NJ3142701Medicaid