Active NPI
Michael Jason Tom, RT
- Vascular-Interventional Technology Radiologic Technologist
- Long Island City, NY
National Provider Identifier
1346860368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular-Interventional Technology Radiologic Technologist
- License
- 012069
- Practice address
- 2510 30TH Ave
Long Island City, NY 11102-2418 - Phone
- (718) 267-4255
- NPI assigned
- Apr 20, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular-Interventional Technology Radiologic Technologist | 2471V0106X | 012069 | NY | Primary |
Addresses
Primary practice location
2510 30TH Ave
Long Island City, NY 11102-2418
Mailing address
2510 30TH Ave
Long Island City, NY 11102-2418
Phone (718) 267-4255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012069 | NY | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587340800000",
"number": "1346860368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2510 30TH AVE",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111022418",
"telephone_number": "718-267-4255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2510 30TH AVE",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111022418",
"telephone_number": "718-267-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOM",
"first_name": "MICHAEL",
"middle_name": "JASON",
"credential": "RT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-20",
"last_updated": "2020-04-20",
"certification_date": "2020-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2471V0106X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Vascular-Interventional Technology",
"state": "NY",
"license": "012069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.