Healthcare Provider Details

I. General information

NPI: 1467949909
Provider Name (Legal Business Name): THOMAS SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016
US

IV. Provider business mailing address

99 NEW ST APT 410
METUCHEN NJ
08840-1977
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone: 917-670-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11410600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: