Provider Demographics
NPI:1861636516
Name:TOMICH, STEPHANIE MARIE (RPA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:TOMICH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2200
Mailing Address - Country:US
Mailing Address - Phone:631-878-7134
Mailing Address - Fax:631-878-5118
Practice Address - Street 1:271 ROUTE 25A
Practice Address - Street 2:SUITE 2
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2014
Practice Address - Country:US
Practice Address - Phone:631-929-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-25
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012822-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant