Provider Demographics
NPI:1336401207
Name:THOMPON, MARILYN ROSEMUND (MS EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ROSEMUND
Last Name:THOMPON
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3909
Mailing Address - Country:US
Mailing Address - Phone:347-689-8960
Mailing Address - Fax:
Practice Address - Street 1:952 E 87TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3909
Practice Address - Country:US
Practice Address - Phone:347-689-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY1691839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist