Healthcare Provider Details

I. General information

NPI: 1801095229
Provider Name (Legal Business Name): THOMAS JOHN GARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST BLACK BUILDING, ROOM 1516
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

630 W 168TH ST BLACK BUILDING, ROOM 1516
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-4116
  • Fax:
Mailing address:
  • Phone: 212-342-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number130718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: