Healthcare Provider Details

I. General information

NPI: 1942217419
Provider Name (Legal Business Name): DENISE THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

44 DEERCHASE LANE
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9767
  • Fax:
Mailing address:
  • Phone: 732-730-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberF350158-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: