Active NPI
Crystal Denise Thompson, RN
- Physical Disabilities Residential Treatment Facility
- Brentwood, NY
National Provider Identifier
1144764028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Disabilities Residential Treatment Facility
- License
- 717469-1
- Practice address
- 73 Orient Ave
Brentwood, NY 11717-1616 - Phone
- (631) 455-2654
- NPI assigned
- Dec 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Disabilities Residential Treatment Facility | 320700000X | 717469-1 | NY | Primary |
Addresses
Primary practice location
73 Orient Ave
Brentwood, NY 11717-1616
Mailing address
73 Orient Ave
Brentwood, NY 11717-1616
Phone (631) 455-2654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 717469-1 | NY | MD | Physical Disabilities Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481500800000",
"number": "1144764028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "73 ORIENT AVE",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117171616",
"telephone_number": "631-455-2654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "73 ORIENT AVE",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117171616",
"telephone_number": "631-455-2654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "CRYSTAL",
"middle_name": "DENISE",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-12",
"last_updated": "2016-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "320700000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Physical Disabilities",
"state": "NY",
"license": "717469-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.