Basic Information
| Provider Information | |||||||||
| NPI: | 1487805800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTIANO | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 255 W SPRING VALLEY AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MAYWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076071445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014878866 | ||||||||
| FaxNumber: | 2014872610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2008 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 25MA08848400 | NJ | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | A115185 | CA | N | Allopathic & Osteopathic Physicians | Urology |
No ID Information.