Provider Demographics
NPI:1649689373
Name:THORNTON, MERRY E (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MERRY
Middle Name:E
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FLINTLOCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2508
Mailing Address - Country:US
Mailing Address - Phone:914-671-3134
Mailing Address - Fax:
Practice Address - Street 1:110 E 55TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4540
Practice Address - Country:US
Practice Address - Phone:212-283-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017766363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical