Provider Demographics
NPI:1225388374
Name:THOMAN, POLLY ANN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:ANN
Last Name:THOMAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 AURORA ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2931
Mailing Address - Country:US
Mailing Address - Phone:716-681-8100
Mailing Address - Fax:
Practice Address - Street 1:231 AURORA ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2931
Practice Address - Country:US
Practice Address - Phone:716-681-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10320587174N00000X
NYL-36606332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174N00000XOther Service ProvidersLactation Consultant, Non-RN