Provider Demographics
NPI:1255864542
Name:THOMAS, MABEL (MS)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 POTTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1830
Mailing Address - Country:US
Mailing Address - Phone:631-587-1800
Mailing Address - Fax:631-587-4676
Practice Address - Street 1:402 POTTER BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1830
Practice Address - Country:US
Practice Address - Phone:631-587-1800
Practice Address - Fax:631-587-4676
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS