Provider Demographics
NPI:1609248665
Name:THOMPSON, ELDON (NP-C)
Entity Type:Individual
Prefix:
First Name:ELDON
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 NJ-27 #100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3252
Mailing Address - Country:US
Mailing Address - Phone:732-745-9900
Mailing Address - Fax:
Practice Address - Street 1:1527 NJ-27 #100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3252
Practice Address - Country:US
Practice Address - Phone:732-745-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307573363LP2300X
NJ26NJ00612900363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care