Healthcare Provider Details

I. General information

NPI: 1780811141
Provider Name (Legal Business Name): F THEMISTOCLE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 ARTHUR AVE
BRONX NY
10458-6003
US

IV. Provider business mailing address

9601 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11429-1327
US

V. Phone/Fax

Practice location:
  • Phone: 718-924-7909
  • Fax:
Mailing address:
  • Phone: 718-924-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number217744
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number217744
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number217774
License Number StateNY

VIII. Authorized Official

Name: FENAR THEMOSTOCLE
Title or Position: OWNER
Credential: MD
Phone: 718-924-7909