Provider Demographics
NPI:1457352072
Name:DAVIES, THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:E ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2722
Mailing Address - Country:US
Mailing Address - Phone:631-581-8828
Mailing Address - Fax:631-581-0545
Practice Address - Street 1:252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:E ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2722
Practice Address - Country:US
Practice Address - Phone:631-581-8828
Practice Address - Fax:631-581-0545
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003229213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4398690001OtherDMERC IDENTIFIER
NY1528227907OtherDMERC NPI
NY00643389Medicaid
NY4398690001OtherDMERC IDENTIFIER
T51028Medicare UPIN