Provider Demographics
NPI:1508922741
Name:FERNDALE ADULT HEALTH N.P. PLLC
Entity Type:Organization
Organization Name:FERNDALE ADULT HEALTH N.P. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-292-1200
Mailing Address - Street 1:653 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-5134
Mailing Address - Country:US
Mailing Address - Phone:845-292-1200
Mailing Address - Fax:845-292-1303
Practice Address - Street 1:653 HARRIS RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-5134
Practice Address - Country:US
Practice Address - Phone:845-292-1200
Practice Address - Fax:845-292-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWQW281Medicare PIN