Provider Demographics
NPI:1386781003
Name:TINI, THOMAS P (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:TINI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 DEER PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3326
Mailing Address - Country:US
Mailing Address - Phone:631-254-0155
Mailing Address - Fax:631-254-0157
Practice Address - Street 1:1941 DEER PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3326
Practice Address - Country:US
Practice Address - Phone:631-254-0155
Practice Address - Fax:631-254-0157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04109Medicare ID - Type Unspecified