MEDICARE: DR. ROBERT A DITOMASSO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	35SI00200900	NJ

General Provider Information

NPI Number	:	1346385440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A DITOMASSO PH.D.

Provider Business Mailing Address
First Line	:	3 WENDEE WAY
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-3527
Country	:	US
Telephone Number	:	856-881-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL TOWER 255 SO. 17 STREET
Second Line	:	SUITE 2708
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103
Country	:	US
Telephone Number	:	215-735-2444
Fax Number	:	215-735-2447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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