Healthcare Provider Details

I. General information

NPI: 1124328141
Provider Name (Legal Business Name): GREGORY RAY THOMAIER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 LAKE AVE
SAINT JAMES NY
11780-2276
US

IV. Provider business mailing address

338 LAKE AVE
SAINT JAMES NY
11780-2276
US

V. Phone/Fax

Practice location:
  • Phone: 631-584-8100
  • Fax: 631-584-9436
Mailing address:
  • Phone: 631-584-8100
  • Fax: 631-584-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX007863
License Number StateNY

VIII. Authorized Official

Name: DR. GREGORY RAY THOMAIER
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: DC
Phone: 631-584-8100