1649434440 NPI number — DR. THOMAS EEDA LO M.D.

Table of content: DR. THOMAS EEDA LO M.D. (NPI 1649434440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649434440 NPI number — DR. THOMAS EEDA LO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LO
Provider First Name:
THOMAS
Provider Middle Name:
EEDA
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:
1649434440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N BEDFORD RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MOUNT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-666-8866
Provider Business Mailing Address Fax Number:
914-666-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 N MIDLAND AVE
Provider Second Line Business Practice Location Address:
NYACK HOSPITAL
Provider Business Practice Location Address City Name:
NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10960-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-348-2862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2008

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: 207L00000X , with the licence number:  265071 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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