Individual
DR. THADDEUS M AVERSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
410 COVENTRY CENTRE DR, PHILLIPSBURG, NJ 08865
(908) 454-9902
(908) 454-9905
Mailing address
PO BOX 27957, SALT LAKE CITY, UT 84127-0957
(908) 835-1910
(908) 835-1924
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB065920
NJ
207Q00000X
Family Medicine Physician
OS008958L
PA
207R00000X
Internal Medicine Physician
OS008958L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0963243
AETNA
NJ
01
—
223733353
HORIZON
NJ
05
—
7437307
—
NJ
Enumeration date
05/03/2006
Last updated
10/14/2016
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