Provider Demographics
NPI:1932168028
Name:THOMSON, WILLIAM G (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:THOMSON
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28-04 BROADWAY
Mailing Address - Street 2:GARDEN STATE ORTHOPAEDIC ASSOCIATES, P.A.
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3913
Mailing Address - Country:US
Mailing Address - Phone:201-791-4434
Mailing Address - Fax:201-475-8996
Practice Address - Street 1:28-04 BROADWAY
Practice Address - Street 2:GARDEN STATE ORTHOPAEDIC ASSOCIATES, P.A.
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3913
Practice Address - Country:US
Practice Address - Phone:201-791-4434
Practice Address - Fax:201-475-8996
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25PA00085800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0008303Medicaid
NJ0008303Medicaid
970028741Medicare PIN
NJ060421DPXMedicare ID - Type Unspecified