Provider Demographics
NPI:1750178976
Name:TOMPKINS, DEMARISA N
Entity type:Individual
Prefix:
First Name:DEMARISA
Middle Name:N
Last Name:TOMPKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:DEMARISA
Other - Middle Name:
Other - Last Name:STEELEYSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1631 PATERSON PLANK RD APT 326
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4173
Mailing Address - Country:US
Mailing Address - Phone:646-241-1419
Mailing Address - Fax:
Practice Address - Street 1:252 W 149TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-2845
Practice Address - Country:US
Practice Address - Phone:929-740-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104613314Medicaid