Provider Demographics
NPI:1750424180
Name:SUCZEWSKI, THOMAS JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:SUCZEWSKI
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 1:323 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4612
Mailing Address - Country:US
Mailing Address - Phone:201-339-8600
Mailing Address - Fax:201-339-2894
Practice Address - Street 1:323 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4612
Practice Address - Country:US
Practice Address - Phone:201-339-8600
Practice Address - Fax:201-339-2894
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 00042842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-2664052OtherFEDERAL TAX ID NO.
NJMA 00042842OtherNEW JERSEY LICENSE NO.
NJMA 00042842OtherNEW JERSEY LICENSE NO.
NJ142569Medicare PIN
AS2540551OtherDEA NO.