Individual
NEIL D THEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10 NATHAN D PERLMAN PLACE, SUITE 12S34, NEW YORK, NY 10003-3851
(212) 420-2124
(212) 420-3449
Mailing address
1900 HEMPSTEAD TPKE, SUITE 500, EAST MEADOW, NY 11554-1724
(516) 542-1090
(770) 666-9097
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
171759
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02441078
—
NY
01
—
92F8970211
NGS
NY
Enumeration date
07/20/2005
Last updated
02/01/2012
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