Individual
MR. TOM R WILLEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT,OCS,MS
Contact information
Practice address
541 CEDAR HILL AVE, WYCKOFF, NJ 07481-2133
(201) 251-2422
(201) 857-0365
Mailing address
541 CEDAR HILL AVE, WYCKOFF, NJ 07481-2133
(201) 251-2422
(201) 857-0365
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
QA 007709
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039725
PERSONAL ID
NJ
01
—
200847370
GROUP ID
NJ
Enumeration date
02/15/2007
Last updated
04/04/2023
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