Provider Demographics
NPI:1871079673
Name:NEUSCHUL, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:NEUSCHUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 83RD AVE APT 2807
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3462
Mailing Address - Country:US
Mailing Address - Phone:516-732-6324
Mailing Address - Fax:
Practice Address - Street 1:22 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4231
Practice Address - Country:US
Practice Address - Phone:631-223-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089728104100000X
NY0885741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker