Individual
THALIA VASILIADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
484 LAFAYETTE AVE, HAWTHORNE, NJ 07506-2522
(973) 423-4770
(973) 423-4816
Mailing address
3 CHESTER PL, ENGLEWOOD, NJ 07631-3613
(201) 568-6205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB074762
NJ
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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