Provider Demographics
NPI:1619002490
Name:ANTONIOS TSOMPANIDIS DO PC
Entity Type:Organization
Organization Name:ANTONIOS TSOMPANIDIS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSOMPANIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-203-0800
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:SUITE 79
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-203-0800
Mailing Address - Fax:732-203-9494
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:SUITE 79
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-203-0800
Practice Address - Fax:732-203-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06310800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN