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General NPI Number Information
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NPI Number | 1972857803
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Entity Type | Organization
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Legal Business Name | MARY J THOMAS MD PC
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 356 VETERANS MEMORIAL HIGHWAY SUITE 6
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City | COMMACK
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State | NY
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Zip | 11725-4343
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Country | US
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Telephone | 631-486-0026
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Fax |
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Provider Business Mailing Address
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Address Line | 422 CLAY PITTS RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3818
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Country | US
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Telephone | 631-486-0026
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. THOMAS JOHN
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Credential |
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Telephone | 631-486-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 226321
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 226321
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License Number State | NY
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