Provider Demographics
NPI:1205004207
Name:PAUL A. TOMCYKOSKI DO PC
Entity Type:Organization
Organization Name:PAUL A. TOMCYKOSKI DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMCYKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-383-5453
Mailing Address - Street 1:1355 ROBERT MELLOW DR
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434
Mailing Address - Country:US
Mailing Address - Phone:570-383-5453
Mailing Address - Fax:570-489-4583
Practice Address - Street 1:1355 ROBERT MELLOW DR
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434
Practice Address - Country:US
Practice Address - Phone:570-383-5453
Practice Address - Fax:570-489-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009027L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017888900002Medicaid