1174551410 NPI number — DR. JOHN THOMAS M.D.

Table of content: DR. JOHN THOMAS M.D. (NPI 1174551410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174551410 NPI number — DR. JOHN THOMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174551410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 286116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-274-4263
Provider Business Mailing Address Fax Number:
866-308-4263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3016 30TH DR
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-274-4263
Provider Business Practice Location Address Fax Number:
866-308-4263
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  043842 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: 219039 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 219039 . This is a "STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11156088 . This is a "CAQH NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043842 . This is a "STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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