Healthcare Provider Details

I. General information

NPI: 1396052015
Provider Name (Legal Business Name): NORTHEAST HAND SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 30TH DR 3RD FLOOR
ASTORIA NY
11102-1874
US

IV. Provider business mailing address

PO BOX 286116
NEW YORK NY
10128-0011
US

V. Phone/Fax

Practice location:
  • Phone: 206-940-4263
  • Fax: 866-308-4263
Mailing address:
  • Phone: 206-940-4263
  • Fax: 866-308-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number219039
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN THOMAS
Title or Position: HAND SURGEON
Credential: MD
Phone: 206-940-4263