MEDICARE: DR. STEPHEN THOMSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	MA035990	NJ
2	207RN0300X	Nephrology Physician	009777	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992733760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN THOMSEN MD

Provider Business Mailing Address
First Line	:	510 31ST STREET
Second Line	:	BASEMENT
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3907
Country	:	US
Telephone Number	:	201-866-3322
Fax Number	:	201-866-2289

Provider Business Practice Location Address
First Line	:	510 31ST STREET
Second Line	:	BASEMENT
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3907
Country	:	US
Telephone Number	:	201-866-3322
Fax Number	:	201-866-2289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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