Justin Thai Thach, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

012085 Issued in NY

Practice address

1217 119TH St
College Point, NY 11356-1648

Phone

(646) 898-7446

NPI assigned

Sep 25, 2007

Last updated

Dec 9, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449619200000",
    "number": "1558558395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 119TH ST",
            "city": "COLLEGE POINT",
            "state": "NY",
            "postal_code": "113561648",
            "telephone_number": "646-898-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 119TH ST",
            "city": "COLLEGE POINT",
            "state": "NY",
            "postal_code": "113561648",
            "telephone_number": "646-898-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACH",
        "first_name": "JUSTIN",
        "middle_name": "THAI",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2015-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "012085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in College Point, NY
• Providers in College Point, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.