Provider Demographics
NPI:1689906992
Name:THOMAS, COURTNEY J
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-0160
Mailing Address - Country:US
Mailing Address - Phone:321-704-7382
Mailing Address - Fax:
Practice Address - Street 1:4317 GLEANE ST FL 3
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2750
Practice Address - Country:US
Practice Address - Phone:321-704-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker