MEDICARE: THOMAS WALTER HODYL M.D.

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	207Q00000X	Family Medicine Physician	212007	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113604525	OTHER		TAX I.D. #

General Provider Information

NPI Number	:	1497849467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WALTER HODYL M.D.

Provider Business Mailing Address
First Line	:	517 OAK ST
Second Line	:	UNIT C.
City	:	COPIAGUE
State	:	NY
Zip	:	11726-3244
Country	:	US
Telephone Number	:	631-842-6680
Fax Number	:	631-842-6682

Provider Business Practice Location Address
First Line	:	517 OAK ST
Second Line	:	UNIT C.
City	:	COPIAGUE
State	:	NY
Zip	:	11726-3244
Country	:	US
Telephone Number	:	631-842-6680
Fax Number	:	631-842-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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