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General NPI Number Information
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NPI Number | 1891701975
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Entity Type | Individual
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Provider Name | JOHN R TOMASULA MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 15 PARK AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7381
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Country | US
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Telephone | 631-581-4400
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Fax | 631-277-3750
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Provider Business Mailing Address
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Address Line | 135 STOOTHOFF RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3921
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Country | US
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Telephone | 631-581-4400
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Fax | 631-277-3750
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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 | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 151000
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 151000
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License Number State | NY
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