Provider Demographics
NPI:1114983434
Name:DOTY, THOMAS S (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:DOTY
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:1099 TARGEE ST
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4310
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-442-9085
Practice Address - Street 1:3311 HYLAN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3688
Practice Address - Country:US
Practice Address - Phone:718-667-7500
Practice Address - Fax:718-351-1580
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010661-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54590Medicare UPIN