Healthcare Provider Details

I. General information

NPI: 1669668737
Provider Name (Legal Business Name): ALFRED A TOMASELLI III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 45TH ST SUITE 301
WEST PALM BEACH FL
33407-2026
US

IV. Provider business mailing address

2151 45TH ST SUITE 301
WEST PALM BEACH FL
33407-2026
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-4401
  • Fax: 561-844-4403
Mailing address:
  • Phone: 561-844-4401
  • Fax: 561-844-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS8387
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS8387
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOS8387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: