Provider Demographics
NPI:1851611719
Name:DEBENEDICTIS, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:DEBENEDICTIS
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 924
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT LIGHT
Mailing Address - State:NJ
Mailing Address - Zip Code:08006-0924
Mailing Address - Country:US
Mailing Address - Phone:609-494-4138
Mailing Address - Fax:
Practice Address - Street 1:54 ANTIOCH ROAD
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF LONG BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08008
Practice Address - Country:US
Practice Address - Phone:609-494-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02328600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology