Healthcare Provider Details

I. General information

NPI: 1366616013
Provider Name (Legal Business Name): SHANTHIE ELIZABETH KOSHY-THOMAS RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3628
US

IV. Provider business mailing address

1 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3628
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-5346
  • Fax: 201-634-5481
Mailing address:
  • Phone: 201-634-5346
  • Fax: 201-634-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012365
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: