Provider Demographics
NPI:1861491110
Name:MEGNA, THOMAS C (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:MEGNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 AMBOY ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-317-9564
Mailing Address - Fax:718-948-9469
Practice Address - Street 1:4634 AMBOY ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-317-9564
Practice Address - Fax:718-948-9469
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161272174400000X
NY161272-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45D571Medicare ID - Type Unspecified
NYA62827Medicare UPIN