Healthcare Provider Details

I. General information

NPI: 1457433518
Provider Name (Legal Business Name): JYOTHI PHILIP THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1043
US

IV. Provider business mailing address

16 BIRCHWOOD PARK DR
SYOSSET NY
11791-6419
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-4525
  • Fax:
Mailing address:
  • Phone: 516-942-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number219887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: