Provider Demographics
NPI:1508265489
Name:THOMPSON CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:THOMPSON CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-410-4789
Mailing Address - Street 1:5 PROFESSIONAL CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2428
Mailing Address - Country:US
Mailing Address - Phone:732-410-4789
Mailing Address - Fax:732-410-4788
Practice Address - Street 1:5 PROFESSIONAL CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2428
Practice Address - Country:US
Practice Address - Phone:732-410-4789
Practice Address - Fax:732-410-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06091200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037415Medicare PIN