Provider Demographics
NPI:1427022557
Name:THOMPSON, JILL B (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:50 MAKAMAH BEACH RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1339
Mailing Address - Country:US
Mailing Address - Phone:631-754-4200
Mailing Address - Fax:631-754-4414
Practice Address - Street 1:847A FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2252
Practice Address - Country:US
Practice Address - Phone:631-754-4200
Practice Address - Fax:631-754-4414
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209825207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02127773Medicaid
NYH64844Medicare UPIN
NY005E51Medicare ID - Type Unspecified