Provider Demographics
NPI:1558440420
Name:PABON, THOMAS MARC (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARC
Last Name:PABON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 112TH ST APT 1P
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5523
Mailing Address - Country:US
Mailing Address - Phone:718-207-2153
Mailing Address - Fax:718-207-2153
Practice Address - Street 1:910 W END AVE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3533
Practice Address - Country:US
Practice Address - Phone:212-851-8102
Practice Address - Fax:212-932-0964
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY08305Medicare PIN
NY00246075Medicaid
NYV8305Medicare PIN
NYA40003643Medicare PIN