Individual
MR. THOMAS BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
100 NICOLLS RD, STONY BROOK, NY 11790-3407
(631) 444-3704
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-3704
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002864-01
NY
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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