Provider Demographics
NPI:1154315703
Name:GIBBONS, THOMAS J (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AUER CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5846
Mailing Address - Country:US
Mailing Address - Phone:732-254-2609
Mailing Address - Fax:732-238-6269
Practice Address - Street 1:8 AUER CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5846
Practice Address - Country:US
Practice Address - Phone:732-254-2609
Practice Address - Fax:732-238-6269
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001948213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4602501Medicaid
NJU17438Medicare UPIN
NJ4602501Medicaid