Healthcare Provider Details

I. General information

NPI: 1255873188
Provider Name (Legal Business Name): EMILIE TOMKINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EMPIRE BLVD STE 100
WEBSTER NY
14580-1934
US

IV. Provider business mailing address

672 TERRACE BLVD
DEPEW NY
14043-3754
US

V. Phone/Fax

Practice location:
  • Phone: 585-787-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023763
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: