Healthcare Provider Details

I. General information

NPI: 1639402092
Provider Name (Legal Business Name): THOMAS F. JAN D.O., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SUNRISE HWY
MASSAPEQUA NY
11758-5311
US

IV. Provider business mailing address

4200 SUNRISE HWY
MASSAPEQUA NY
11758-5311
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-1064
  • Fax: 516-798-9070
Mailing address:
  • Phone: 516-541-1064
  • Fax: 516-798-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number204322-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number204322-1
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS F. JAN
Title or Position: PRESIDENT
Credential: D.O
Phone: 516-541-1064