Provider Demographics
NPI:1760606644
Name:THOMAS, MARY (DPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3103
Mailing Address - Country:US
Mailing Address - Phone:631-277-8900
Mailing Address - Fax:631-277-0298
Practice Address - Street 1:2330 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3103
Practice Address - Country:US
Practice Address - Phone:631-277-8900
Practice Address - Fax:631-277-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006184213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery