Provider Demographics
NPI:1629192802
Name:THOMAS A. KIEWLICZ
Entity Type:Organization
Organization Name:THOMAS A. KIEWLICZ
Other - Org Name:FLYNN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KIEWLICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-235-8110
Mailing Address - Street 1:8 GROVE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7797
Mailing Address - Country:US
Mailing Address - Phone:781-235-8110
Mailing Address - Fax:
Practice Address - Street 1:8 GROVE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7797
Practice Address - Country:US
Practice Address - Phone:781-235-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003266OtherBCBSMA
MA686701OtherTUFTS HEALTH PLAN
MA686701OtherTUFTS HEALTH PLAN