Basic Information
| Provider Information | |||||||||
| NPI: | 1689317711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 RESEARCH RD | ||||||||
| Address2: | |||||||||
| City: | RIDGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119612701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317513000 | ||||||||
| FaxNumber: | 6317510506 | ||||||||
| Practice Location | |||||||||
| Address1: | 365 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317513000 | ||||||||
| FaxNumber: | 6317510506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2022 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 348337 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.