Healthcare Provider Details

I. General information

NPI: 1841562014
Provider Name (Legal Business Name): ROLANDO LLULL TOMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1502 GARDEN DR APT 7
OCEAN NJ
07712-7610
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4420
  • Fax:
Mailing address:
  • Phone: 732-492-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09143800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: