Healthcare Provider Details

I. General information

NPI: 1073624441
Provider Name (Legal Business Name): TOMASZ J NIEWIAROWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/29/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S NEW ST STE 201
BETHLEHEM PA
18015-1652
US

IV. Provider business mailing address

306 S NEW ST STE 201
BETHLEHEM PA
18015-1112
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-0113
  • Fax: 610-974-8589
Mailing address:
  • Phone: 610-866-0113
  • Fax: 610-974-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD040218L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: