Provider Demographics
NPI:1609923739
Name:THOMPSON, SEAN LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:LEONARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONARD
Other - Middle Name:SEAN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6511 BOOTH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4181
Mailing Address - Country:US
Mailing Address - Phone:718-806-1434
Mailing Address - Fax:718-806-1435
Practice Address - Street 1:175-61 HILLSIDE AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-291-1300
Practice Address - Fax:718-291-1330
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08975400207X00000X
NY253711207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery