Healthcare Provider Details

I. General information

NPI: 1417072802
Provider Name (Legal Business Name): THOMAS H. NEILANS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDEN OAKS STE 200
ROCHESTER NY
14625-2840
US

IV. Provider business mailing address

100 LINDEN OAKS STE 200
ROCHESTER NY
14625-2840
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-1600
  • Fax: 585-586-7951
Mailing address:
  • Phone: 585-586-1600
  • Fax: 585-586-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: