Provider Demographics
NPI:1033492426
Name:TRAMONTOZZI, DONATO
Entity Type:Individual
Prefix:MR
First Name:DONATO
Middle Name:
Last Name:TRAMONTOZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHICKEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2105
Mailing Address - Country:US
Mailing Address - Phone:516-759-5219
Mailing Address - Fax:
Practice Address - Street 1:1770 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5203
Practice Address - Country:US
Practice Address - Phone:631-667-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI043814-1183500000X
FLPS 29634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist