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General NPI Number Information
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NPI Number | 1649369554
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Entity Type | Individual
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Provider Name | THOMAS J IZQUIERDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3757 91ST ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7901
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Country | US
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Telephone | 718-779-7697
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Fax | 718-457-2402
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Provider Business Mailing Address
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Address Line | 2 SEVEN SPRINGS CT
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City | HUNTINGTON
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State | NY
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Zip | 11743-1006
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Country | US
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Telephone | 631-424-8002
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Fax | 718-457-2402
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 156124
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License Number State | NY
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