Provider Demographics
NPI:1790206720
Name:TOMLIN, ALBERT JR (OWNER)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:TOMLIN
Suffix:JR
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ABERDEEN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1212
Mailing Address - Country:US
Mailing Address - Phone:585-532-8868
Mailing Address - Fax:585-270-5138
Practice Address - Street 1:121 ABERDEEN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619
Practice Address - Country:US
Practice Address - Phone:585-532-8868
Practice Address - Fax:585-270-5138
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253792262172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver