Tom, Jack Philip
Tom, Jack Philip is an sole proprietor health care provider with primary practice located at 207 Hallock Rd Suite 211, Stony Brook NY 11790-3033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Tom, Jack Philip can be contacted via phone (631) 444-0004.Contact Information
Primary practice address
207 Hallock Rd Suite 211
Stony Brook NY 11790-3033
Phone: (631) 444-0004
Fax: (631) 444-0088
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 155342 | New York |
Profile Details
| NPI number | 1093724239 |
|---|---|
| LBN Legal business name | Tom, Jack Philip |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 5th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093724239 | NPPES |
| New York | MEDICAID | 01711760 |
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