1326496514 NPI number — MR. MICHAL JAN TOMASZEWICZ PMHNP

Table of content: MR. MICHAL JAN TOMASZEWICZ PMHNP (NPI 1326496514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326496514 NPI number — MR. MICHAL JAN TOMASZEWICZ PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMASZEWICZ
Provider First Name:
MICHAL
Provider Middle Name:
JAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326496514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
748 LOCUST GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-6928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-354-5424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 FOULK RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19803-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-478-6199
Provider Business Practice Location Address Fax Number:
302-354-7162
Provider Enumeration Date:
05/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  L8-0000143 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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