Provider Demographics
NPI:1467447458
Name:WITOMSKI, THOMAS F (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:WITOMSKI
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 1:2100 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6102
Mailing Address - Country:US
Mailing Address - Phone:732-988-1234
Mailing Address - Fax:732-988-8794
Practice Address - Street 1:2100 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-988-1234
Practice Address - Fax:732-988-8794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA217002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2273608Medicaid
NJ2273608Medicaid
NJ415732B54Medicare ID - Type Unspecified