Healthcare Provider Details

I. General information

NPI: 1225660913
Provider Name (Legal Business Name): WINAND J THOMAS JR. RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

79 POTOMAC AVE SE APT 730
WASHINGTON DC
20003-3696
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone: 504-427-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-79772
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: