Provider Demographics
NPI:1255330890
Name:TOMMASULO, BARBARA C (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:C
Last Name:TOMMASULO
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:900 FRANKLIN AVE
Mailing Address - Street 2:ORZAC CENTER FOR EXTENDED CARE AND REHABILITATION
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2145
Mailing Address - Country:US
Mailing Address - Phone:516-256-6551
Mailing Address - Fax:516-256-6143
Practice Address - Street 1:900 FRANKLIN AVE
Practice Address - Street 2:ORZAC CENTER FOR EXTENDED CARE AND REHABILITATION
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2145
Practice Address - Country:US
Practice Address - Phone:516-256-6551
Practice Address - Fax:516-256-6143
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173288207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01403983Medicaid
NY16F031OtherPROVIDER
NY173288OtherHIP OF NEW YORK-HEALTH PL
NYD92206Medicare UPIN