Healthcare Provider Details

I. General information

NPI: 1710241047
Provider Name (Legal Business Name): ADELINE THERMIDOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SOUTH 3 STREET
BROOKLYN NY
11236
US

IV. Provider business mailing address

325 SOUTH 3 STREET
BROOKLYN NY
11236
US

V. Phone/Fax

Practice location:
  • Phone: 718-387-7820
  • Fax: 718-387-7391
Mailing address:
  • Phone: 718-387-7820
  • Fax: 718-387-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number322364-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: