Healthcare Provider Details

I. General information

NPI: 1841643376
Provider Name (Legal Business Name): MS. JULIE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE MILSTEIN BUILDING - 8TH FLOOR
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

1850 VIRGINIA AVE
ELMONT NY
11003-4930
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-7236
  • Fax:
Mailing address:
  • Phone: 516-504-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: