Provider Demographics
NPI:1215355615
Name:THOMAS, ANILA (MD)
Entity Type:Individual
Prefix:
First Name:ANILA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1329
Mailing Address - Country:US
Mailing Address - Phone:516-312-1366
Mailing Address - Fax:
Practice Address - Street 1:2154 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2239
Practice Address - Country:US
Practice Address - Phone:516-409-8800
Practice Address - Fax:516-409-4921
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY280928208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-4762421Medicaid