Individual
BRANDON THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
470 DEKALB AVE, BROOKLYN, NY 11205-4448
(585) 981-9613
Mailing address
470 DEKALB AVE, BROOKLYN, NY 11205-4448
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
713261
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298591
—
NY
Enumeration date
01/02/2020
Last updated
01/02/2020
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