Provider Demographics
NPI:1477732691
Name:THOMAS, BINDHU KANJIRAVILAYIL (MD)
Entity Type:Individual
Prefix:
First Name:BINDHU
Middle Name:KANJIRAVILAYIL
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 1:151 KNOLLCROFT RD BLDG 135
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NJ
Mailing Address - Zip Code:07939-5001
Mailing Address - Country:US
Mailing Address - Phone:908-647-0180
Mailing Address - Fax:908-604-5206
Practice Address - Street 1:151 KNOLLCROFT RD BLDG 135
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:908-604-5206
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246044207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA1111Medicare UPIN