Healthcare Provider Details

I. General information

NPI: 1801290390
Provider Name (Legal Business Name): DOMENICO TOLOMEO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK AVE
YONKERS NY
10703-2934
US

IV. Provider business mailing address

301 KIRKMAN AVE
ELMONT NY
11003-3119
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-4300
  • Fax:
Mailing address:
  • Phone: 516-351-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: