Individual
SUNIL R THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 EAGLE AVE, SUITE 100, OCEAN, NJ 07712
(732) 660-6200
(732) 775-6142
Mailing address
1200 EAGLE AVE, SUITE 100, OCEAN, NJ 07712-7631
(732) 660-6200
(732) 775-6142
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA07218400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20023925
RAILROAD MEDICARE
NJ
Enumeration date
02/19/2007
Last updated
05/18/2018
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