Provider Demographics
NPI:1760525257
Name:THOMAS, MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GREEN POND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2013
Mailing Address - Country:US
Mailing Address - Phone:973-627-6010
Mailing Address - Fax:973-625-9424
Practice Address - Street 1:35 GREEN POND RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2013
Practice Address - Country:US
Practice Address - Phone:973-627-6010
Practice Address - Fax:973-625-9424
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06949400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics