Provider Demographics
NPI:1336220193
Name:DE ANGELIS, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DE ANGELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROSELAND
Other - Middle Name:OBSTETRICS &
Other - Last Name:GYNECOLOGY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:27 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5605
Mailing Address - Country:US
Mailing Address - Phone:908-561-1102
Mailing Address - Fax:908-561-1106
Practice Address - Street 1:27 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5605
Practice Address - Country:US
Practice Address - Phone:908-561-1102
Practice Address - Fax:908-561-1106
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05372700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF60514Medicare UPIN
NJ035762Medicare PIN