Provider Demographics
NPI:1992780316
Name:THAW, EMERALD M (MD)
Entity type:Individual
Prefix:
First Name:EMERALD
Middle Name:M
Last Name:THAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIDINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-8639
Mailing Address - Country:US
Mailing Address - Phone:908-431-5868
Mailing Address - Fax:908-431-5868
Practice Address - Street 1:5908 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4071
Practice Address - Country:US
Practice Address - Phone:718-439-8488
Practice Address - Fax:718-492-9643
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182819207KA0200X
NJMA53549207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2645068OtherOXFORD
NY01392410Medicaid
NY5271429OtherCIGNA
NJ8827907Medicaid
NY267340201OtherHEALTH PLUS
NYP2117240OtherOXFORD
NY01392410Medicaid
NJ054215Medicare ID - Type Unspecified
NY5271429OtherCIGNA