Provider Demographics
NPI:1396007092
Name:THOMAS, AMY S (MED)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 SKYLINE DR.
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830
Mailing Address - Country:US
Mailing Address - Phone:607-368-0428
Mailing Address - Fax:
Practice Address - Street 1:10605 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3263
Practice Address - Country:US
Practice Address - Phone:607-368-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist