Provider Demographics
NPI:1992725113
Name:THOMAIER, GREGORY RAY (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RAY
Last Name:THOMAIER
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 1:338 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2224
Mailing Address - Country:US
Mailing Address - Phone:631-584-8100
Mailing Address - Fax:631-584-9436
Practice Address - Street 1:338 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2224
Practice Address - Country:US
Practice Address - Phone:631-584-8100
Practice Address - Fax:631-584-9436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007863111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5898286OtherGHI
NYP1092926OtherOXFORD
NYX4K141OtherEMPIRE BC/BS
NYP-11067587OtherMULTIPLAN
NY1824490OtherUNITED HEALTHCARE
NYAA50665OtherMDNY
NY113468347-01OtherPRISM (VYTRA PANEL)
NYP-11067587OtherMULTIPLAN
NYU66033Medicare UPIN