Provider Demographics
NPI:1598064545
Name:KOLE, THOMAS PEDICINO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PEDICINO
Last Name:KOLE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VALLEY HEALTH PLZ
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3628
Mailing Address - Country:US
Mailing Address - Phone:201-634-5403
Mailing Address - Fax:201-634-5765
Practice Address - Street 1:1 VALLEY HEALTH PLZ
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3628
Practice Address - Country:US
Practice Address - Phone:201-634-5403
Practice Address - Fax:201-634-5765
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA097781002085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472948Medicare PIN