Healthcare Provider Details

I. General information

NPI: 1134178122
Provider Name (Legal Business Name): EVANGELIA TSOMOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 E RTE 4
PARAMUS NJ
07652-5101
US

IV. Provider business mailing address

PO BOX 1173 VALLEY EMERGENCY ROOM ASSOCIATES PA
RIDGEWOOD NJ
07451
US

V. Phone/Fax

Practice location:
  • Phone: 551-222-0800
  • Fax:
Mailing address:
  • Phone: 800-777-2455
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA06713200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7770901
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: