=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528227907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS DAVIES DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2008
-----------------------------------------------------
Last Update Date | 08/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 252 E MAIN ST
-----------------------------------------------------
City | EAST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11730-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-581-8828
-----------------------------------------------------
Fax | 631-581-0545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 252 E MAIN ST
-----------------------------------------------------
City | EAST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11730-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-581-8828
-----------------------------------------------------
Fax | 631-581-0545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ELAINE CONTONA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-581-8828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------