Individual
DR. CHARLENE MARIE THOMESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
79 MIDDLEVILLE RD # 116A, NORTHPORT, NY 11768-2200
(631) 754-7963
(631) 754-9350
Mailing address
79 MIDDLEVILLE RD # 116A, NORTHPORT, NY 11768-2200
(631) 754-7963
(631) 754-9350
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
168653
NY
2084P0800X
Psychiatry Physician
Primary
168653
NY
Other
Enumeration date
03/01/2006
Last updated
07/11/2007
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