1295006344 NPI number — PSYCHIATRIC ASSOCIATES OF SOUTHERN NJ

Table of content: RICHARD CHARLES THOMASON JR. MD (NPI 1396951596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295006344 NPI number — PSYCHIATRIC ASSOCIATES OF SOUTHERN NJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC ASSOCIATES OF SOUTHERN NJ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295006344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 GOSLING CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SICKLERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08081-4882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 FRIES MILL RD
Provider Second Line Business Practice Location Address:
SUITE E3
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-885-8036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
EBONI
Authorized Official Middle Name:
Authorized Official Title or Position:
APN
Authorized Official Telephone Number:
856-885-8036

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  26NJ00332200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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