Antonios Tsompanidis DO PC
Organization Active NPI Family Medicine Physician · Hazlet, NJ
NPI 1619002490 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1619002490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 25MB06310800 (NJ)
- Legal business name
- ANTONIOS TSOMPANIDIS DO PC
- Practice address
- 1 Bethany Rd
Suite 79
Hazlet, NJ 07730-1663 - Phone
- (732) 203-0800
- Fax
- (732) 203-9494
- NPI assigned
- Feb 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Antonios Tsompanidis, DO
- Title
- Owner
- Phone
- (732) 203-0800
Practitioners 2
-
Dinamarie Perrino, D.O.
-
Antonios J Tsompanidis, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D0967359 | Antonios Tsompanidis DO PC | Certificate of waiver | Nov 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101102000658 | NJ | Part B Supplier - Clinic/Group Practice | 4688868813 |
Receives reassigned benefits from 2 practitioners Practice locations: Hazlet, NJ |
National Provider Directory
Locations
1 Bethany Rd
Ste 79
Hazlet, NJ 07730
Phone (732) 203-0800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 25MB06310800 | NJ | Yes |
Addresses
Primary practice location
1 Bethany Rd
Suite 79
Hazlet, NJ 07730-1663
Mailing address
1 Bethany Rd
Suite 79
Hazlet, NJ 07730-1663
Phone (732) 203-0800
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All providers in Hazlet, NJ · Family Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.