1356495824 NPI number — DR. THOMAS D EUSTACE PHD

Table of content: DR. THOMAS D EUSTACE PHD (NPI 1356495824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356495824 NPI number — DR. THOMAS D EUSTACE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EUSTACE
Provider First Name:
THOMAS
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1356495824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 611
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKTOWN HTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10598-0611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-962-3442
Provider Business Mailing Address Fax Number:
914-962-4332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 FARESE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMAWALK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10501-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-962-3442
Provider Business Practice Location Address Fax Number:
914-962-4332
Provider Enumeration Date:
01/22/2007

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: 103TC0700X , with the licence number:  0059391 , 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: 57661 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: WS167 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y047096 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60005939NY . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: WS0001037 . This is a "SELECTPRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110726 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01449958 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1034116 . This is a "METRACOMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: PVPB80927 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7114043 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP318503 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: V50761 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003182 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25831 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 703156 . This is a "MTCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO10005939 . This is a "STAMET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C0901 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




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