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General NPI Number Information
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NPI Number | 1104150820
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Entity Type | Individual
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Provider Name | SUSAN THOMAS NP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 1048 N 5TH ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2940
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Country | US
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Telephone | 516-354-0245
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Fax | 888-216-4294
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Provider Business Mailing Address
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Address Line | 1048 N 5TH ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2940
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Country | US
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Telephone | 516-354-0245
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Fax | 888-216-4294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F304906-1
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License Number State | NY
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