Healthcare Provider Details

I. General information

NPI: 1063009413
Provider Name (Legal Business Name): THOMAS A KOWALEWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MORRIS AVE
LONG BRANCH NJ
07740-6537
US

IV. Provider business mailing address

205 MORRIS AVE
LONG BRANCH NJ
07740-6537
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-6400
  • Fax:
Mailing address:
  • Phone: 732-222-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number28RW04001700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: