Provider Demographics
NPI:1508903147
Name:THOMAS, CHRISTMAS JERREL (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTMAS
Middle Name:JERREL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ASHFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2719
Mailing Address - Country:US
Mailing Address - Phone:718-864-8415
Mailing Address - Fax:
Practice Address - Street 1:1249 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4413
Practice Address - Country:US
Practice Address - Phone:212-360-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011583-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical