Provider Demographics
NPI:1801859517
Name:TOMLINSON-PHELAN, MICHELLE A (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:TOMLINSON-PHELAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 HIGHWAY 18
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4909
Mailing Address - Country:US
Mailing Address - Phone:732-257-1171
Mailing Address - Fax:732-257-2618
Practice Address - Street 1:754 STATE ROUTE 18
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4909
Practice Address - Country:US
Practice Address - Phone:732-257-1171
Practice Address - Fax:732-257-2618
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05206100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225103Medicaid
NJE56734Medicare UPIN
NJ626855Medicare PIN