Provider Demographics
NPI:1639402092
Name:THOMAS F. JAN D.O., PC
Entity Type:Organization
Organization Name:THOMAS F. JAN D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-541-1064
Mailing Address - Street 1:4200 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5311
Mailing Address - Country:US
Mailing Address - Phone:516-541-1064
Mailing Address - Fax:516-798-9070
Practice Address - Street 1:4200 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5311
Practice Address - Country:US
Practice Address - Phone:516-541-1064
Practice Address - Fax:516-798-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204322-1208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty