Healthcare Provider Details

I. General information

NPI: 1861691412
Provider Name (Legal Business Name): DEAN M. TOMASELLO M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AVENUE OF TWO RIVERS
RUMSON NJ
07760-1702
US

IV. Provider business mailing address

10 AVENUE OF TWO RIVERS
RUMSON NJ
07760-1702
US

V. Phone/Fax

Practice location:
  • Phone: 732-492-1142
  • Fax: 732-842-5726
Mailing address:
  • Phone: 732-492-1142
  • Fax: 732-842-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08040900
License Number StateNJ

VIII. Authorized Official

Name: DR. DEAN M TOMASELLO
Title or Position: OWNER
Credential: M.D.
Phone: 732-492-1142