Provider Demographics
NPI:1598971814
Name:RIEBESELL, THOMAS E (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:RIEBESELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MADISON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-845-8722
Mailing Address - Fax:201-845-0836
Practice Address - Street 1:22 MADISON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-845-8722
Practice Address - Fax:201-845-0836
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T98287Medicare UPIN
R1619035Medicare ID - Type Unspecified