Individual
THOMAS JAMES MACEDON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 667-2600
Mailing address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 667-2600
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
748910
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2997157
—
NY
Enumeration date
09/26/2018
Last updated
09/26/2018
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