Healthcare Provider Details

I. General information

NPI: 1083310841
Provider Name (Legal Business Name): JAYCY THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYCY THOMAS SOHAN NP

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 FRANKLIN AVE
GARDEN CITY NY
11530-1617
US

IV. Provider business mailing address

14 WALL ST FL 9
NEW YORK NY
10005-2178
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3511
  • Fax: 516-663-4780
Mailing address:
  • Phone: 646-501-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: