Provider Demographics
NPI:1972857803
Name:MARY J THOMAS MD PC
Entity Type:Organization
Organization Name:MARY J THOMAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-486-0026
Mailing Address - Street 1:422 CLAY PITTS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3818
Mailing Address - Country:US
Mailing Address - Phone:631-486-0026
Mailing Address - Fax:
Practice Address - Street 1:356 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4343
Practice Address - Country:US
Practice Address - Phone:631-486-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226321261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health