Provider Demographics
NPI:1093056400
Name:THOMPSON, ALISHA MARIA
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:MARIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYANA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:254 CLINTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1608
Mailing Address - Country:US
Mailing Address - Phone:917-830-5239
Mailing Address - Fax:
Practice Address - Street 1:254 CLINTON AVE APT 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1608
Practice Address - Country:US
Practice Address - Phone:917-830-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374J00000X, 101YP1600X
NY291636164W00000X
NJ225A00000X, 343900000X
SC55818164W00000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXB12968XMedicaid