Provider Demographics
NPI:1497782940
Name:AGESEN, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:AGESEN
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 1:299 CHERRY HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1124
Mailing Address - Country:US
Mailing Address - Phone:973-998-8301
Mailing Address - Fax:973-998-8302
Practice Address - Street 1:299 CHERRY HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1124
Practice Address - Country:US
Practice Address - Phone:973-998-8301
Practice Address - Fax:973-998-8302
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07245700208100000X
NJ25MA7245700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004341Medicaid
H41959Medicare UPIN
NJ0004341Medicaid
NJH41959Medicare UPIN
NJ049280Medicare ID - Type Unspecified