Provider Demographics
NPI:1164461927
Name:FEOLA, THOMAS JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:FEOLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 BELCHASE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9728
Mailing Address - Country:US
Mailing Address - Phone:732-583-4800
Mailing Address - Fax:732-583-0448
Practice Address - Street 1:100 BELCHASE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-9728
Practice Address - Country:US
Practice Address - Phone:732-583-4800
Practice Address - Fax:732-583-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD002635213EP1101X
NJ25MD00263500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8476306Medicaid
NJ046920Medicare ID - Type Unspecified
NJU81357Medicare UPIN