MEDICARE: EMERALD M THAW MD

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	207KA0200X	Allergy Physician	182819	NY
2	207KA0200X	Allergy Physician	MA53549	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2645068	OTHER	NJ	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5271429	OTHER	NY	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	267340201	OTHER	NY	HEALTH PLUS
6	P2117240	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1992780316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMERALD M THAW MD

Provider Business Mailing Address
First Line	:	30 RIDINGS PKWY
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-8639
Country	:	US
Telephone Number	:	908-431-5868
Fax Number	:	908-431-5868

Provider Business Practice Location Address
First Line	:	5908 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4071
Country	:	US
Telephone Number	:	718-439-8488
Fax Number	:	718-492-9643

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	02/19/2014

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