Basic Information
| Provider Information | |||||||||
| NPI: | 1285049262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | TOLTAKU | ||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7024 RISING SUN AVE | ||||||||
| Address2: | APT B-G04 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191113972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153139060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLZ STE 134 | ||||||||
| Address2: | BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182406347 | ||||||||
| FaxNumber: | 7182406516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2014 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.