=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982720926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN B. TOMAKA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 RIDGE RD
-----------------------------------------------------
City | LACKAWANNA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14218-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-903-6367
-----------------------------------------------------
Fax | 716-662-7048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 RIDGE RD
-----------------------------------------------------
City | LACKAWANNA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14218-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-903-6367
-----------------------------------------------------
Fax | 716-662-7048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 077361
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------