Provider Demographics
NPI:1295597573
Name:THOMPSON, PHILLIP MICHAEL
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1118 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6967
Practice Address - Country:US
Practice Address - Phone:609-888-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty