Healthcare Provider Details

I. General information

NPI: 1336702091
Provider Name (Legal Business Name): THOMAS TOOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BROAD ST
HAMILTON NY
13346-9575
US

IV. Provider business mailing address

150 BROAD ST
HAMILTON NY
13346-9575
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-7040
  • Fax: 315-501-1070
Mailing address:
  • Phone: 315-824-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number332474
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number332474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: