Provider Demographics
NPI:1124375035
Name:THOMAS, ALEX THAYIL
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:THAYIL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 47TH AVENUE #2120 D (2ND FLOOR)
Mailing Address - Street 2:ALLIED MEDIX RESOURCES INC.
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2302
Mailing Address - Country:US
Mailing Address - Phone:917-995-7510
Mailing Address - Fax:
Practice Address - Street 1:12023 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2635
Practice Address - Country:US
Practice Address - Phone:562-869-0978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist