Provider Demographics
NPI:1487089496
Name:THOMAS, JOAN ROSEMARIE (SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ROSEMARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 MERRICK BLVD
Mailing Address - Street 2:APT 2K
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4148
Mailing Address - Country:US
Mailing Address - Phone:917-603-9295
Mailing Address - Fax:
Practice Address - Street 1:8805 MERRICK BLVD
Practice Address - Street 2:APT 2K
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4148
Practice Address - Country:US
Practice Address - Phone:917-603-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist