MEDICARE: MS. KAREN THOMAS MS ED

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	174400000X	Specialist	504801041	NY

General Provider Information

NPI Number	:	1407108244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN THOMAS MS ED

Provider Business Mailing Address
First Line	:	1474 BEACH CHANNEL DR
Second Line	:	1B
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3165
Country	:	US
Telephone Number	:	917-535-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1474 BEACH CHANNEL DR
Second Line	:	1B
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3165
Country	:	US
Telephone Number	:	917-535-1025
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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