Provider Demographics
NPI:1295794642
Name:TOMASZEWSKI, CHARLES S (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:TOMASZEWSKI
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 1:1255 HIGHWAY 70
Mailing Address - Street 2:#33-S
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5900
Mailing Address - Country:US
Mailing Address - Phone:732-364-1664
Mailing Address - Fax:732-364-1667
Practice Address - Street 1:1255 HIGHWAY 70
Practice Address - Street 2:#33-S
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5900
Practice Address - Country:US
Practice Address - Phone:732-364-1664
Practice Address - Fax:732-364-1667
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21555174400000X
NJ25MA07964400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123391Medicaid
AZ134544Medicaid
AZZMD21555Medicare ID - Type Unspecified
AZ134544Medicaid
NJ0123391Medicaid