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General NPI Number Information
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NPI Number | 1689760951
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Entity Type | Individual
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Provider Name | TOM A TASSAKIS MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 1550 E CHESTNUT AVE BUILDING 4 SUITE D
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City | VINELAND
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State | NJ
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Zip | 08361
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Country | US
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Telephone | 856-691-1910
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Fax | 856-691-8330
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | SWEDESBORO
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State | NJ
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Zip | 08085-0062
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Country | US
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Telephone | 856-467-0390
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Fax | 856-467-9747
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA06255100
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License Number State | NJ
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