MEDICARE: PROF. ALVETTA THOMPASIONAS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	000-577-1	NY

General Provider Information

NPI Number	:	1740294875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ALVETTA THOMPASIONAS P.A.

Provider Business Mailing Address
First Line	:	8335 139TH ST
Second Line	:	APT 5A
City	:	BRIARWOOD
State	:	NY
Zip	:	11435-1600
Country	:	US
Telephone Number	:	718-441-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 COURT ST
Second Line	:	SUITE 901
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4859
Country	:	US
Telephone Number	:	718-855-7707
Fax Number	:	718-855-7717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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