Basic Information
| Provider Information | |||||||||
| NPI: | 1861636516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMICH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | CENTER MORICHES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119342200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318787134 | ||||||||
| FaxNumber: | 6318785118 | ||||||||
| Practice Location | |||||||||
| Address1: | 271 ROUTE 25A | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WADING RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117922014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319291256 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2009 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 012822-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.