Healthcare Provider Details

I. General information

NPI: 1942202965
Provider Name (Legal Business Name): PAUL ANTHONY TOMCYKOSKI D.O.,F.A.A.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N BLAKELY ST
DUNMORE PA
18512-1935
US

IV. Provider business mailing address

516 N BLAKELY ST
DUNMORE PA
18512-1935
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-7388
  • Fax: 570-344-7323
Mailing address:
  • Phone: 570-344-7388
  • Fax: 570-344-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS-009027-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierOS-009027-L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: