Basic Information
| Provider Information | |||||||||
| NPI: | 1316081268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAYAL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 668 MAIN ST | ||||||||
| Address2: | STE 4 | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080485016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092677050 | ||||||||
| FaxNumber: | 6092677065 | ||||||||
| Practice Location | |||||||||
| Address1: | 668 MAIN ST | ||||||||
| Address2: | STE 4 | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080485016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092677050 | ||||||||
| FaxNumber: | 6092677065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 11/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA04862500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5487803 | 05 | NJ | MEDICAID |