Provider Demographics
NPI:1437208089
Name:TOMASELLI, JAMES (NYSLO, ABOC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:TOMASELLI
Suffix:
Gender:M
Credentials:NYSLO, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 68TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6618
Mailing Address - Country:US
Mailing Address - Phone:134-722-3408
Mailing Address - Fax:
Practice Address - Street 1:130 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3510
Practice Address - Country:US
Practice Address - Phone:151-667-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008493156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician