Provider Demographics
NPI:1710226238
Name:THAAS MEDICAL, LLC
Entity Type:Organization
Organization Name:THAAS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHIRGAMATHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KURUNATHAPILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-901-7487
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-0425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5302
Practice Address - Country:US
Practice Address - Phone:845-901-7487
Practice Address - Fax:845-357-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02878673Medicaid
NY02878673Medicaid