Provider Demographics
NPI:1407934748
Name:GOLEBIEWSKI, THOMAS HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:GOLEBIEWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RANO BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2729
Mailing Address - Country:US
Mailing Address - Phone:607-231-5000
Mailing Address - Fax:607-231-5111
Practice Address - Street 1:109 RANO BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2729
Practice Address - Country:US
Practice Address - Phone:607-231-5000
Practice Address - Fax:607-231-5111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009336-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU74752Medicare UPIN
NYBB4579Medicare ID - Type Unspecified