Provider Demographics
NPI:1205866571
Name:YARED, THOMAS ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALBERT
Last Name:YARED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2742
Mailing Address - Country:US
Mailing Address - Phone:516-255-5527
Mailing Address - Fax:
Practice Address - Street 1:137 BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2742
Practice Address - Country:US
Practice Address - Phone:516-255-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1258042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY321981Medicare PIN