Provider Demographics
NPI:1144054693
Name:THOMPSON STREET MEDICAL PC
Entity type:Organization
Organization Name:THOMPSON STREET MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-397-4755
Mailing Address - Street 1:168 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2509
Mailing Address - Country:US
Mailing Address - Phone:212-397-4755
Mailing Address - Fax:
Practice Address - Street 1:168 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2509
Practice Address - Country:US
Practice Address - Phone:212-397-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory