Provider Demographics
NPI:1174551410
Name:THOMAS, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286116
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0011
Mailing Address - Country:US
Mailing Address - Phone:718-274-4263
Mailing Address - Fax:866-308-4263
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-274-4263
Practice Address - Fax:866-308-4263
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043842207XS0106X
NY2190392082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY219039OtherSTATE LICENSE
11156088OtherCAQH NUMBER
CT043842OtherSTATE LICENSE
CT043842OtherSTATE LICENSE