Provider Demographics
NPI:1578666582
Name:MILITANA, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MILITANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 STONE PL
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3426
Mailing Address - Country:US
Mailing Address - Phone:914-337-8300
Mailing Address - Fax:914-337-8884
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3426
Practice Address - Country:US
Practice Address - Phone:914-337-8300
Practice Address - Fax:914-337-8884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY193351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01502932Medicaid
NY80H861Medicare ID - Type Unspecified
NY01502932Medicaid