Provider Demographics
NPI:1447342647
Name:BIRCH, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BIRCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-0140
Mailing Address - Country:US
Mailing Address - Phone:973-616-7117
Mailing Address - Fax:973-616-7338
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:973-616-7117
Practice Address - Fax:973-616-7338
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05917200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2X4411OtherEMPIRE
NJP3565794OtherOXFORD
NJPENDINGMedicaid
NJ2495227-019OtherCIGNA
NJ2K6719OtherHEALTHNET
NJ6804004Medicaid
NJ6804004Medicaid
NJ2X4411OtherEMPIRE
NJPENDINGMedicaid