Provider Demographics
NPI:1942273958
Name:BOMALASKI, JOHN J
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BOMALASKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-752-0944
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1130 HICKORY ST STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-752-0944
Practice Address - Fax:321-434-7590
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71006207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32474XOtherHFMG MA
FL000433300Medicaid
FL32474YMedicare PIN
FL32474XMedicare PIN