Healthcare Provider Details

I. General information

NPI: 1972601946
Provider Name (Legal Business Name): THOMAS CONREY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21615 NORTHERN BLVD
BAYSIDE NY
11361
US

IV. Provider business mailing address

98120 QUEENS BLVD APT 16
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax: 718-830-9088
Mailing address:
  • Phone: 718-830-0246
  • Fax: 718-830-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: