Healthcare Provider Details

I. General information

NPI: 1679743595
Provider Name (Legal Business Name): THOMAS M DEALY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 ATLANTIC AVE
EAST ROCKAWAY NY
11518-1517
US

IV. Provider business mailing address

PO BOX 122
GARDEN CITY NY
11530-0122
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-2233
  • Fax: 516-596-3285
Mailing address:
  • Phone: 516-993-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045820-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: