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General NPI Number Information
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NPI Number | 1861028433
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Entity Type | Individual
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Provider Name | EMMANNUEL THOMAS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 600 ROE AVE
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City | ELMIRA
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State | NY
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Zip | 14905-1629
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Country | US
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Telephone | 607-737-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 163 HILTON DR
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City | HORSEHEADS
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State | NY
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Zip | 14845-1834
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Country | US
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Telephone | 917-705-9089
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F345273-01
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License Number State | NY
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