Individual
CARLOS THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25319 148TH AVE, ROSEDALE, NY 11422-2829
(518) 260-8128
Mailing address
25319 148TH AVE, ROSEDALE, NY 11422-2829
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
568106-1
NY
Other
Enumeration date
05/06/2019
Last updated
05/06/2019
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