Provider Demographics
NPI:1487254330
Name:NAGEL, THOMAS J (PA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PA
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 297
Mailing Address - Street 2:
Mailing Address - City:FORT MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:10922-0297
Mailing Address - Country:US
Mailing Address - Phone:845-825-2258
Mailing Address - Fax:
Practice Address - Street 1:57 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:FORT MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:10922
Practice Address - Country:US
Practice Address - Phone:845-825-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant