Healthcare Provider Details

I. General information

NPI: 1750216271
Provider Name (Legal Business Name): LATISHA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WILLOUGHBY ST
BROOKLYN NY
11201-5257
US

IV. Provider business mailing address

205 E 39TH ST
BROOKLYN NY
11203-2904
US

V. Phone/Fax

Practice location:
  • Phone: 929-585-5014
  • Fax:
Mailing address:
  • Phone: 347-612-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: