Provider Demographics
NPI:1679646608
Name:TSOMPANIDIS, ANTONIOS J (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTONIOS
Middle Name:J
Last Name:TSOMPANIDIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY ROAD
Mailing Address - Street 2:SUITE 79
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1668
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06310800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ906420Medicare ID - Type Unspecified
NJG49154Medicare UPIN