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General NPI Number Information
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NPI Number | 1841363025
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Entity Type | Organization
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Legal Business Name | THOMAS W LOEB MD PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 994 FIFTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10028
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Country | US
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Telephone | 212-327-3700
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Fax | 212-327-4506
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Provider Business Mailing Address
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Address Line | 16103 HORACE HARDING EXPWY
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City | FRESH MEADOWS
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State | NY
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Zip | 11365
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Country | US
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Telephone | 718-461-9400
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Fax | 718-461-4003
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS W LOEB
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Credential | MD
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Telephone | 212-327-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 147494
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License Number State | NY
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