JACK PHILIP TOM


Address: 207 Hallock Rd, Suite 211, Stony Brook, NY 11790-3033
Phone: 6314440004

JACK PHILIP TOM (NPI# 1093724239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1093724239
Entity Type Individual
Full Name JACK PHILIP TOM
Credential M.D.
Practice Address 207 Hallock Rd
Suite 211
Stony Brook
NY 11790-3033
Practice Telephone 6314440004
Practice Fax Number 6314440088
Mailing Telephone 6314440004
Mailing Fax Number 6314440088
Enumeration Date 2006-08-05
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology 155342 NY Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NY 01711760 05

Office Location

Street Address 207 HALLOCK RD
SUITE 211
City STONY BROOK
State NY
Zip Code 11790-3033

Providers in the same location

NPI Name Taxonomy Address Enumeration
1851361414 Peter Smith Podiatrist 207 Hallock Rd, Suite 4, Stony Brook, NY 11790-3033 2006-01-25
1720646805 Samantha Lynn Renieris Speech-Language Pathologist 207 Hallock Rd, Stony Brook, NY 11790-3033 2019-06-03
1518451459 Jessica Liberty Speech-Language Pathologist 207 Hallock Rd, Stony Brook, NY 11790-3033 2018-06-14
1922501964 Melissa M Schachter Speech-Language Pathologist 207 Hallock Rd, Stony Brook, NY 11790-3033 2018-03-15
1891217774 Marisa Massaro Family Medicine 207 Hallock Rd, Stony Brook, NY 11790-3033 2017-07-12
1497289037 Stony Brook Oral and Facial Surgery PC Dentist 207 Hallock Rd, Suite 2, Stony Brook, NY 11790-3033 2017-04-19
1306394978 Doughty and Ryzova Medical Group PC Pediatrics 207 Hallock Rd, Suite 106, Stony Brook, NY 11790-3033 2016-09-13
1376099226 Mireille Toughey Registered Nurse 207 Hallock Rd, Stony Brook, NY 11790-3033 2016-08-31
1518360197 Marianne Kaminski Registered Nurse 207 Hallock Rd, Stony Brook, NY 11790-3033 2014-09-26
1962803163 Dianne Munnich Registered Nurse 207 Hallock Rd, Stony Brook, NY 11790-3033 2014-09-08
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1649807678 Ribu Mathew Student in an Organized Health Care Education/Training Program Health Science Center T16, Room 020, Stony Brook, NY 11790 2020-03-27
1538794821 Chaoyang Qu Student in an Organized Health Care Education/Training Program 9 Syncamore Dr, Stonybrook, NY 11790 2020-03-06
1457814824 Brain & Spine Surgery, P.C. Neurological Surgery 2500 Nesconset Hwy., Bldg 18c, Stony Brook, NY 11790 2019-04-11
1447759741 Susan Cuccia Registered Nurse 40 Sheppard Lane, Stony Brook, NY 11790 2018-02-02
1972022234 Carol M Doherty Specialist 7 Haskel Lane, Stony Brook, NY 11790 2017-09-18
1972021582 Louren M Gonzales Nurse Practitioner 100 Nicolls Rd Hsc Level 4 Room 120, Hsc Level 4 Room 120, Stony Brook, NY 11790 2017-09-04
1043740954 Asma Khattak Behavior Technician 90 Quaker Path, Stony Brook, NY 11790 2017-06-13
1427452846 Christina Georgia Registered Nurse 36 Ivy League Lane, Stony Brook, NY 11790 2014-10-14
1124361654 Mandeep Kainth Student in an Organized Health Care Education/Training Program Department of Medicine Hsc Level 16, 020, Suny Stony Brook, Stony Brook, NY 11790 2013-04-03
1922357144 Audry M Luciano Registered Nurse 2500 Nesconset Hwy Bldg 23, Stony Brook, NY 11790 2012-09-04
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Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1023062973 Joann N Salvemini Dermatology 1320 Stony Brook Rd Ste 200, Stony Brook, NY 11790 2006-05-22
1265434682 James Joseph Briley Jr. Dermatology 1320 Stony Brook Rd Bldg F2nd, Stony Brook, NY 11790-2206 2005-08-15
1699025635 Elyse S Rafal M D P C Dermatology 2500 Route 347, Building 22a, Stony Brook, NY 11790-2555 2012-09-18
1841396546 Amy Wishner Steinberg Dermatology 2500 Route 347, Bldg 5a Amy Wishner Steinberg Md, Stony Brook, NY 11790-2555 2006-09-16
1497700819 Stony Brook Dermatology Associates, University Faculty Practice Corpor Dermatology Suny @ Stony Brook, Hsc, L16, Rm 060, Stony Brook, NY 11794-0001 2006-05-24
1477515781 Elyse S. Rafal Dermatology 2500 Route 347, Building 22a, Stony Brook, NY 11790-2555 2006-04-03

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1225636384 Markowitz Medical Pllc Dermatology 1150 5th Ave # Suire1a, New York, NY 10128-0724 2020-10-12
1114545985 Tarek Yamany Md Pllc Dermatology 229 W 60th St Apt 8e, New York, NY 10023-7507 2020-07-08
1952924839 Elizabeth Jessica Ranelli Dermatology 16 W 17th St, New York, NY 10011-5738 2020-05-26
1841811148 Stuart Daniel Shanler Dermatology 53 Underhill Dr, Pomona, NY 10970-2668 2020-04-28
1740800309 Ns Arora Dermatology Pllc Dermatology 99 Jericho Tpke Ste 110, Jericho, NY 11753-1015 2020-04-23
1174163406 Halite Services Crop Dermatology 447 Rose Ln, Rockville Centre, NY 11570-1429 2020-01-15
1235776485 Libby Rhee Do Dermatology Pllc Dermatology 110 E 60th St # 800, New York, NY 10022-1688 2019-12-06
1588214357 Advanced Dermatology of New York PC Dermatology 1-3 West 125th Street, New York, NY 10027 2019-09-13
1568018588 Mary Matina Valinotti Dermatology 332 E Main St Ste 1, Bay Shore, NY 11706-8436 2019-08-15
1831751379 Jessica Weiser, M.d., Pllc Dermatology 155 Spring St Fl 5, New York, NY 10012-5208 2019-07-05
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Competitor

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City STONY BROOK
Zip Code 11790

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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