Provider Demographics
NPI:1972637791
Name:ALAN JAMES TOMCZAK
Entity type:Organization
Organization Name:ALAN JAMES TOMCZAK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOMCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-796-6543
Mailing Address - Street 1:11290 LAKE PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-8706
Mailing Address - Country:US
Mailing Address - Phone:814-796-6543
Mailing Address - Fax:
Practice Address - Street 1:11290 LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-8706
Practice Address - Country:US
Practice Address - Phone:814-796-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010723010001OtherPROVIDER ID