Healthcare Provider Details

I. General information

NPI: 1639325483
Provider Name (Legal Business Name): RUSSELL HERMAN TOMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SOUTH ORANGE AVENUE VH C107
NEWARK NJ
07103-2714
US

IV. Provider business mailing address

185 SOUTH ORANGE AVENUE UH C107
NEWARK NJ
07103-2714
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4086
  • Fax:
Mailing address:
  • Phone: 973-972-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA08450200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number25MA08450200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: