Healthcare Provider Details

I. General information

NPI: 1154580785
Provider Name (Legal Business Name): GEORGE THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST STARR-4
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

520 E 70TH ST # ST4
NEW YORK NY
10021-9800
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2158
  • Fax: 212-746-6951
Mailing address:
  • Phone: 212-746-2158
  • Fax: 212-746-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35085130
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number254320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: