Provider Demographics
NPI:1114916459
Name:HOM, THOMAS SHELWAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SHELWAH
Last Name:HOM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PARK ROW
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5000
Mailing Address - Country:US
Mailing Address - Phone:212-732-1329
Mailing Address - Fax:212-732-6005
Practice Address - Street 1:185 PARK ROW
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5000
Practice Address - Country:US
Practice Address - Phone:212-732-1329
Practice Address - Fax:212-732-6005
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00306083Medicaid