Provider Demographics
NPI:1144369992
Name:THOMAS, EDWIDGE (DNP, ANP)
Entity type:Individual
Prefix:
First Name:EDWIDGE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 24TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-998-9420
Mailing Address - Fax:212-995-4243
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9420
Practice Address - Fax:212-995-4243
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300839363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90V451Medicare ID - Type Unspecified
NYS45254Medicare UPIN