Healthcare Provider Details

I. General information

NPI: 1851754154
Provider Name (Legal Business Name): JAMES THOMAS ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MARCUS AVE STE 102
NEW HYDE PARK NY
11042-1008
US

IV. Provider business mailing address

2800 MARCUS AVE STE 102
NEW HYDE PARK NY
11042-1008
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6100
  • Fax: 516-662-6091
Mailing address:
  • Phone: 516-622-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number309887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: