Healthcare Provider Details

I. General information

NPI: 1528768793
Provider Name (Legal Business Name): BROOKE THORNHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 JERICHO TPKE
FLORAL PARK NY
11001-2146
US

IV. Provider business mailing address

4 REMSEN ST
EAST NORTHPORT NY
11731-4927
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5439
  • Fax:
Mailing address:
  • Phone: 631-316-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: