Provider Demographics
NPI:1326380270
Name:BOMMARITTO, THERESA K
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:K
Last Name:BOMMARITTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2244
Mailing Address - Country:US
Mailing Address - Phone:607-734-3649
Mailing Address - Fax:
Practice Address - Street 1:708 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2244
Practice Address - Country:US
Practice Address - Phone:607-734-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist