Healthcare Provider Details

I. General information

NPI: 1073505012
Provider Name (Legal Business Name): JOSEPH THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3583
US

IV. Provider business mailing address

1344 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3583
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-4932
  • Fax: 631-698-2453
Mailing address:
  • Phone: 631-698-4932
  • Fax: 631-698-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: