Provider Demographics
NPI:1457661373
Name:WOODING, THOMAS SAMUEL (REGISTERED PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SAMUEL
Last Name:WOODING
Suffix:
Gender:M
Credentials:REGISTERED PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 HAMILTON PL APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6860
Mailing Address - Country:US
Mailing Address - Phone:631-398-3000
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3393
Practice Address - Country:US
Practice Address - Phone:631-574-2580
Practice Address - Fax:631-574-2585
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23-006995363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical