Healthcare Provider Details

I. General information

NPI: 1225388374
Provider Name (Legal Business Name): POLLY ANN THOMAN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 AURORA ST
LANCASTER NY
14086-2931
US

IV. Provider business mailing address

231 AURORA ST
LANCASTER NY
14086-2931
US

V. Phone/Fax

Practice location:
  • Phone: 716-681-8100
  • Fax:
Mailing address:
  • Phone: 716-681-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberL-36606
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10320587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: