Healthcare Provider Details

I. General information

NPI: 1609923739
Provider Name (Legal Business Name): SEAN LEONARD THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEONARD SEAN THOMPSON MD

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175-61 HILLSIDE AVENUE SUITE 400
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

6511 BOOTH ST SUITE 1C
REGO PARK NY
11374-4181
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-1300
  • Fax: 718-291-1330
Mailing address:
  • Phone: 718-806-1434
  • Fax: 718-806-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA08975400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number253711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: