Provider Demographics
NPI:1174676100
Name:TOMASEK, VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:TOMASEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2539
Mailing Address - Country:US
Mailing Address - Phone:973-857-3451
Mailing Address - Fax:973-857-4368
Practice Address - Street 1:74 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2539
Practice Address - Country:US
Practice Address - Phone:973-857-3451
Practice Address - Fax:973-857-4368
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100338900103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ879992Medicare ID - Type UnspecifiedPSYCHOLOGIST