Provider Demographics
NPI:1770723686
Name:THOMPSON, PETER JAMES
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
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 1:7 HEGEMAN AVE
Mailing Address - Street 2:7A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4756
Mailing Address - Country:US
Mailing Address - Phone:347-993-8882
Mailing Address - Fax:
Practice Address - Street 1:7 HEGEMAN AVE
Practice Address - Street 2:7A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4756
Practice Address - Country:US
Practice Address - Phone:347-993-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295650-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse