Healthcare Provider Details

I. General information

NPI: 1669689360
Provider Name (Legal Business Name): DIANNE THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 STATE ST
HACKENSACK NJ
07601-5463
US

IV. Provider business mailing address

445 CENTRAL AVENUE
HACKENSACK NJ
07601-1448
US

V. Phone/Fax

Practice location:
  • Phone: 201-457-1500
  • Fax: 201-457-1501
Mailing address:
  • Phone: 201-343-1671
  • Fax: 201-343-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2168681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMAO70598
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: