Provider Demographics
NPI:1649554577
Name:SPORTS MEDICINE & ORTHOPAEDIC SURGERY P.C.
Entity type:Organization
Organization Name:SPORTS MEDICINE & ORTHOPAEDIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-939-0212
Mailing Address - Street 1:355 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3452
Mailing Address - Country:US
Mailing Address - Phone:516-939-0212
Mailing Address - Fax:516-939-2517
Practice Address - Street 1:355 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3452
Practice Address - Country:US
Practice Address - Phone:516-939-0212
Practice Address - Fax:516-939-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1522341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36D691OtherMEDICARE ID
NYC09166Medicare UPIN