Provider Demographics
NPI:1538131727
Name:KAYLEN, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KAYLEN
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 1:904 OAK TREE AVE
Mailing Address - Street 2:STE F
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5126
Mailing Address - Country:US
Mailing Address - Phone:732-563-1211
Mailing Address - Fax:732-563-4104
Practice Address - Street 1:904 OAK TREE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5126
Practice Address - Country:US
Practice Address - Phone:908-755-7688
Practice Address - Fax:908-755-2960
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06308900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7299109Medicaid
NJG50394Medicare UPIN
NJ7299109Medicaid