Provider Demographics
NPI:1689760951
Name:TASSAKIS, TOM A (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:A
Last Name:TASSAKIS
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:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-0062
Mailing Address - Country:US
Mailing Address - Phone:856-467-0390
Mailing Address - Fax:856-467-9747
Practice Address - Street 1:1550 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 4 SUITE D
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-691-1910
Practice Address - Fax:856-691-8330
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06255100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00613557OtherRAILROAD MEDICARE
NJ663940200Medicaid
NJ663940200Medicaid
NJ777488DR4Medicare PIN