=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205148798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER TOMASELLO D O P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2010
-----------------------------------------------------
Last Update Date | 07/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 E HALLANDALE BEACH BLVD
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-9091
-----------------------------------------------------
Fax | 954-454-1711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 220371
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33022-0371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-9091
-----------------------------------------------------
Fax | 954-454-1711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PETER A TOMASELLO JR.
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 954-454-9091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------