Provider Demographics
NPI:1619906047
Name:THOMAS, JOHNNY (DO)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 92ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7929
Mailing Address - Country:US
Mailing Address - Phone:718-639-3603
Mailing Address - Fax:718-639-3605
Practice Address - Street 1:3703 92ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7929
Practice Address - Country:US
Practice Address - Phone:718-639-3603
Practice Address - Fax:718-639-3605
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine