Healthcare Provider Details

I. General information

NPI: 1396274445
Provider Name (Legal Business Name): MARY A TOMPKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BURDETT AVE
TROY NY
12180-2487
US

IV. Provider business mailing address

187 HIGHWAY 36 STE 230
WEST LONG BRANCH NJ
07764-1306
US

V. Phone/Fax

Practice location:
  • Phone: 518-953-7876
  • Fax:
Mailing address:
  • Phone: 732-702-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340705
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: