Provider Demographics
NPI:1700869708
Name:NYLK, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:NYLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOMASZ
Other - Middle Name:
Other - Last Name:NYLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:775-356-4514
Mailing Address - Fax:
Practice Address - Street 1:2385 E PRATER WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9629
Practice Address - Country:US
Practice Address - Phone:775-356-4514
Practice Address - Fax:775-356-4991
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89193207RC0000X
NV12300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89193OtherMEDICAL LICENSE
11762408OtherCAQH
NV12300OtherMEDICAL LICENSE
1700869708OtherNPI
CACA114485Medicare PIN
11762408OtherCAQH
1700869708OtherNPI