Healthcare Provider Details

I. General information

NPI: 1801337167
Provider Name (Legal Business Name): THOMAS JOHN LAVIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 66TH RD
FOREST HILLS NY
11375-2029
US

IV. Provider business mailing address

45 HIGH PASTURE CIR
DIX HILLS NY
11746-5620
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-4352
  • Fax:
Mailing address:
  • Phone: 516-225-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number309577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: