Basic Information
Provider Information
NPI: 1588605802
EntityType: 2
ReplacementNPI:  
OrganizationName: TJH MEDICAL SERVICES, PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: JAMAICA HOSPITAL AMBULATORY CARE CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 80 MARCUS DR
Address2: PROVIDER ENROLLMENT
City: MELVILLE
State: NY
PostalCode: 117474230
CountryCode: US
TelephoneNumber: 6313917700
FaxNumber: 6314544163
Practice Location
Address1: 8900 VAN WYCK EXPY
Address2:  
City: JAMAICA
State: NY
PostalCode: 114182897
CountryCode: US
TelephoneNumber: 7182067001
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DIMARIA
AuthorizedOfficialFirstName: ANTHONY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7182065134
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM1300X  Y Ambulatory Health Care FacilitiesClinic/CenterMulti-Specialty

ID Information
IDTypeStateIssuerDescription
0143652005NY MEDICAID


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