Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 043842 | CT |
Y | 2082S0105X | Plastic Hand Surgeon | 219039 | NY |
NPI | 1174551410 |
---|---|
Provider Name | Dr. John Thomas |
First Address | New York, NY 10128-0011 |
Second Address | Long Island City, NY 11102-1874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043842 | STATE LICENSE (01) | CT |
11156088 | CAQH NUMBER (01) | |
219039 | STATE LICENSE (01) | NY |
I16247 | (02) |