Healthcare Provider Details

I. General information

NPI: 1912691072
Provider Name (Legal Business Name): EAST COAST BONE AND JOINT SURGEON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17561 HILLSIDE AVE STE 400
JAMAICA NY
11432-5769
US

IV. Provider business mailing address

17561 HILLSIDE AVE STE 400
JAMAICA NY
11432-5769
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD S THOMPSON
Title or Position: OWNER
Credential: MD
Phone: 718-291-1300