Provider Demographics
NPI:1447744594
Name:THOMAS, AVINASH (PA)
Entity Type:Individual
Prefix:
First Name:AVINASH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26008 73RD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1030
Mailing Address - Country:US
Mailing Address - Phone:516-770-8331
Mailing Address - Fax:
Practice Address - Street 1:2015 W MAIN ST # 350
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4536
Practice Address - Country:US
Practice Address - Phone:203-863-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant