MEDICARE: THOMAS S. DOTY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010661-1	NY

General Provider Information

NPI Number	:	1114983434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS S. DOTY P.A.

Provider Business Mailing Address
First Line	:	1099 TARGEE ST
Second Line	:	ADMINISTRATION
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4310
Country	:	US
Telephone Number	:	718-448-3210
Fax Number	:	718-442-9085

Provider Business Practice Location Address
First Line	:	3311 HYLAN BLVD
Second Line	:	2ND FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3688
Country	:	US
Telephone Number	:	718-667-7500
Fax Number	:	718-351-1580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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