1336518216 NPI number — MR. GILBERT HILAIRE THOMSON PT

Table of content: MR. GILBERT HILAIRE THOMSON PT (NPI 1336518216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336518216 NPI number — MR. GILBERT HILAIRE THOMSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMSON
Provider First Name:
GILBERT
Provider Middle Name:
HILAIRE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336518216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HELLBROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ULSTER PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12487-5209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-658-7735
Provider Business Mailing Address Fax Number:
845-658-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2255 PLATTE CLOVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKA PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12427-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-589-5103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  016216 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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