Healthcare Provider Details

I. General information

NPI: 1164877064
Provider Name (Legal Business Name): PETER VINCENT TUMMINELLI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 02/09/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST DOC STE 3300
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

183 S ORANGE AVE STE F-1560
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2800
  • Fax:
Mailing address:
  • Phone: 973-972-3606
  • Fax: 973-972-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME150036
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA10805000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: