Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA10210400 | NJ |
Y | 208600000X | Surgeon | 25MA10210400 | NJ |
N | 208200000X | Surgeon | 4301105996 | MI |
N | 208600000X | Surgeon | 4301105996 | MI |
N | 2086S0102X | Surgical Critical Care | 4301105996 | MI |
N | 2086S0120X | Pediatric Surgery | 4301105996 | MI |
NPI | 1619104213 |
---|---|
Provider Name | Tina Theresa Thomas |
First Address | Hackensack, NJ 07601-1941 |
Second Address | Hackensack, NJ 07601-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 19/09/2018 |