Provider Demographics
NPI:1699083022
Name:THOMAS, ENA M
Entity type:Individual
Prefix:
First Name:ENA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ENA
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:105-37 65 AVE
Mailing Address - Street 2:APT2G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1821
Mailing Address - Country:US
Mailing Address - Phone:718-897-1428
Mailing Address - Fax:718-897-1428
Practice Address - Street 1:3041 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5126
Practice Address - Country:US
Practice Address - Phone:718-615-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse