Provider Demographics
NPI:1548441074
Name:THOMAIER, JEFFREY KARL (DC, AT,C)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KARL
Last Name:THOMAIER
Suffix:
Gender:M
Credentials:DC, AT,C
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:2007-11-27
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009503111N00000X
NY000623-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY825722OtherACN GROUP
NYP2686248OtherOXFORD
NYX009503OtherHIP
NY825722OtherACN GROUP
NYU83619Medicare UPIN