Provider Demographics
NPI:1962681643
Name:MARK THOMPSON ACUPUNCTURE AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MARK THOMPSON ACUPUNCTURE AND PHYSICAL THERAPY
Other - Org Name:MARK THOMPSON ACUTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PT, DPT
Authorized Official - Phone:212-974-7240
Mailing Address - Street 1:485 MADISON AVE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5803
Mailing Address - Country:US
Mailing Address - Phone:212-974-7240
Mailing Address - Fax:212-974-7228
Practice Address - Street 1:485 MADISON AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5803
Practice Address - Country:US
Practice Address - Phone:212-974-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001044171100000X
NY011079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty