Provider Demographics
NPI:1497849467
Name:HODYL, THOMAS WALTER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WALTER
Last Name:HODYL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 OAK ST
Mailing Address - Street 2:UNIT C.
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-3244
Mailing Address - Country:US
Mailing Address - Phone:631-842-6680
Mailing Address - Fax:631-842-6682
Practice Address - Street 1:517 OAK ST
Practice Address - Street 2:UNIT C.
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3244
Practice Address - Country:US
Practice Address - Phone:631-842-6680
Practice Address - Fax:631-842-6682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
113604525OtherTAX I.D. #
113604525OtherTAX I.D. #
17V711Medicare ID - Type Unspecified