Healthcare Provider Details

I. General information

NPI: 1992780316
Provider Name (Legal Business Name): EMERALD M THAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 5TH AVE
BROOKLYN NY
11220-4071
US

IV. Provider business mailing address

30 RIDINGS PKWY
PRINCETON NJ
08540-8639
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-8488
  • Fax: 718-492-9643
Mailing address:
  • Phone: 908-431-5868
  • Fax: 908-431-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number182819
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA53549
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: