Provider Demographics
NPI:1275512220
Name:MALANOWSKI, THOMAS G (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:MALANOWSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2355
Mailing Address - Country:US
Mailing Address - Phone:716-372-1570
Mailing Address - Fax:716-373-2096
Practice Address - Street 1:211 ERIE ST
Practice Address - Street 2:
Practice Address - City:LITTLE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14755-1011
Practice Address - Country:US
Practice Address - Phone:716-938-9666
Practice Address - Fax:716-938-9668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000453-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02471754Medicaid
NYR53946Medicare UPIN
NYDD7124Medicare ID - Type Unspecified