Provider Demographics
NPI:1326448754
Name:TUCHMAN, JACK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:TUCHMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BEACH CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3618
Mailing Address - Country:US
Mailing Address - Phone:845-234-1317
Mailing Address - Fax:
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:PHYSICIAN ASSISTANT SERVICES
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:845-483-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical