Healthcare Provider Details

I. General information

NPI: 1104244920
Provider Name (Legal Business Name): THOMAS CHARLES VESNESKI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 403
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-3113
  • Fax:
Mailing address:
  • Phone: 856-356-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00489600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: