Healthcare Provider Details

I. General information

NPI: 1699074807
Provider Name (Legal Business Name): BINU K. THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

15 OAKVILLE ST
STATEN ISLAND NY
10314-5027
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7828
  • Fax:
Mailing address:
  • Phone: 718-761-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number531060-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: