Provider Demographics
NPI:1558542142
Name:THOMPSON, PHILIP J (FNP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BLANTYRE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2005
Mailing Address - Country:US
Mailing Address - Phone:716-836-8042
Mailing Address - Fax:
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:MILLARD FILLMORE GATES - CENTRAL VERIFICATION OFFICE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-887-4663
Practice Address - Fax:716-887-4298
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily