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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 19 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1093724239 NPPES
New York MEDICAID 01711760

Popular Providers