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General NPI Number Information
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NPI Number | 1417090697
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Entity Type | Individual
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Provider Name | TOM R WILLEMANN PT,OCS,MS
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 541 CEDAR HILL AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-2133
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Country | US
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Telephone | 201-251-2422
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Fax | 201-857-0365
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Provider Business Mailing Address
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Address Line | 541 CEDAR HILL AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-2133
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Country | US
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Telephone | 201-251-2422
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Fax | 201-857-0365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | QA 007709
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License Number State | NJ
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