Healthcare Provider Details

I. General information

NPI: 1588605802
Provider Name (Legal Business Name): TJH MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
JAMAICA NY
11418-2897
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-7001
  • Fax:
Mailing address:
  • Phone: 631-391-7700
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY DIMARIA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-206-5134