Healthcare Provider Details

I. General information

NPI: 1043479306
Provider Name (Legal Business Name): THOMAS JOSEPH FRIA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD # 117C
LYONS NJ
07939-5001
US

IV. Provider business mailing address

1420 18TH AVE APARTMENT 28
WALL TOWNSHIP NJ
07719-3762
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 908-794-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00071300
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: