Provider Demographics
NPI:1801883277
Name:AHLBORN, THOMAS NESBITT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:NESBITT
Last Name:AHLBORN
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 1:385 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1543
Mailing Address - Country:US
Mailing Address - Phone:201-444-5757
Mailing Address - Fax:201-444-0184
Practice Address - Street 1:385 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1543
Practice Address - Country:US
Practice Address - Phone:201-444-5757
Practice Address - Fax:201-444-0184
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48848208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3715108Medicaid
NJ3715108Medicaid
NJE60694Medicare UPIN