Healthcare Provider Details

I. General information

NPI: 1467949909
Provider Name (Legal Business Name): THOMAS SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PARK ST STE 312
MONTCLAIR NJ
07042-2960
US

IV. Provider business mailing address

70 PARK ST STE 312
MONTCLAIR NJ
07042-2960
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-4995
  • Fax: 201-342-7171
Mailing address:
  • Phone: 201-342-2550
  • Fax: 201-342-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11410600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: