Provider Demographics
NPI:1508213976
Name:THOMPSON, GEORGE KENNETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KENNETH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9 SUNNY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2214
Mailing Address - Country:US
Mailing Address - Phone:914-714-3350
Mailing Address - Fax:845-354-2168
Practice Address - Street 1:9 SUNNY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:NEW HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:10977-2214
Practice Address - Country:US
Practice Address - Phone:914-714-3350
Practice Address - Fax:845-354-2168
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical