Healthcare Provider Details

I. General information

NPI: 1114864915
Provider Name (Legal Business Name): ERICA R THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 LOCUST ST
CENTRAL ISLIP NY
11722-4312
US

IV. Provider business mailing address

293 PARKWAY BLVD
WYANDANCH NY
11798-4300
US

V. Phone/Fax

Practice location:
  • Phone: 621-526-3937
  • Fax:
Mailing address:
  • Phone: 631-526-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number311134822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: