Provider Demographics
NPI:1174612295
Name:CASSIDY, THOMAS JAMES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:CASSIDY
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 1:3910 PARK AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3062
Mailing Address - Country:US
Mailing Address - Phone:732-767-3130
Mailing Address - Fax:732-767-3134
Practice Address - Street 1:3910 PARK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3062
Practice Address - Country:US
Practice Address - Phone:732-767-3130
Practice Address - Fax:732-767-3134
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07090900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH23208Medicare UPIN
NJ041356Medicare ID - Type Unspecified