Provider Demographics
NPI:1336701622
Name:DEMPSEY, IAN TODD (AGACNP)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:TODD
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 21ST ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1836
Mailing Address - Country:US
Mailing Address - Phone:505-414-8116
Mailing Address - Fax:
Practice Address - Street 1:50 E 21ST ST APT 6E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1836
Practice Address - Country:US
Practice Address - Phone:505-414-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657164163WC0200X
NY431529363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine