Healthcare Provider Details

I. General information

NPI: 1043373574
Provider Name (Legal Business Name): THOMAS MARTIN REHM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7713 79 PLACE
GLENDALE NY
11385
US

IV. Provider business mailing address

7713 79 PLACE
GLENDALE NY
11385
US

V. Phone/Fax

Practice location:
  • Phone: 718-417-3344
  • Fax: 718-418-4124
Mailing address:
  • Phone: 718-417-3344
  • Fax: 718-418-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number144115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: