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General NPI Number Information
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NPI Number | 1811351950
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Entity Type | Individual
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Provider Name | ALIYA TOMASULO
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 3636 33RD ST STE 500
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City | LONG ISLAND CITY
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State | NY
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Zip | 11106-2329
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Country | US
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Telephone | 212-529-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 28 CORN TASSLE RD
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City | DANBURY
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State | CT
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Zip | 06811-3225
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Country | US
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Telephone | 518-269-7976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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