Provider Demographics
NPI:1811293145
Name:THOMAS, JASON H (AUD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:H
Last Name:THOMAS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 RICHMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-966-9466
Mailing Address - Fax:718-966-9464
Practice Address - Street 1:78 TODT HILL - SUITE 202
Practice Address - Street 2:TODT HILL AUDIOLOGICAL SVS
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-816-1952
Practice Address - Fax:718-816-5118
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002326231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM04871Medicare PIN