Individual
LACEYANNE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2638 28TH ST, ASTORIA, NY 11102-2044
(718) 509-9345
Mailing address
65 BELKNAP AVE, YONKERS, NY 10710-5403
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
754614
NY
207Q00000X
Family Medicine Physician
Primary
F356932-01
NY
Other
Enumeration date
04/16/2025
Last updated
07/25/2025
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