Healthcare Provider Details

I. General information

NPI: 1336358860
Provider Name (Legal Business Name): SERGE YVES THOMASSINI RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

149 DEAN ST
VALLEY STREAM NY
11580-4909
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4526
  • Fax:
Mailing address:
  • Phone: 516-837-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number005989-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: