Provider Demographics
NPI:1649369554
Name:IZQUIERDO, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:IZQUIERDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 SEVEN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1006
Mailing Address - Country:US
Mailing Address - Phone:631-424-8002
Mailing Address - Fax:718-457-2402
Practice Address - Street 1:3757 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7901
Practice Address - Country:US
Practice Address - Phone:718-779-7697
Practice Address - Fax:718-457-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY156124207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062922Medicaid
NY17E021Medicare ID - Type Unspecified
NYB10188Medicare ID - Type Unspecified