Healthcare Provider Details

I. General information

NPI: 1174551410
Provider Name (Legal Business Name): JOHN THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 30TH DR 3RD FLOOR
LONG ISLAND CITY NY
11102-1874
US

IV. Provider business mailing address

PO BOX 286116
NEW YORK NY
10128-0011
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-4263
  • Fax: 866-308-4263
Mailing address:
  • Phone: 718-274-4263
  • Fax: 866-308-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number043842
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number219039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: