MEDICARE: GREGORY RAY THOMAIER DC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	X007863	NY

General Provider Information

NPI Number	:	1124328141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY RAY THOMAIER DC PC

Provider Business Mailing Address
First Line	:	338 LAKE AVE
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2276
Country	:	US
Telephone Number	:	631-584-8100
Fax Number	:	631-584-9436

Provider Business Practice Location Address
First Line	:	338 LAKE AVE
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2276
Country	:	US
Telephone Number	:	631-584-8100
Fax Number	:	631-584-9436

Authorized Official
Title or Position	:	PRESIDENT/CHIROPRACTOR
Name	:	DR. GREGORY RAY THOMAIER
Credential	:	DC
Telephone Number	:	631-584-8100

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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