Provider Demographics
NPI:1760990204
Name:TOMAIKO, MARIE THERESE (BS)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE
Last Name:TOMAIKO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3507
Mailing Address - Country:US
Mailing Address - Phone:973-229-3198
Mailing Address - Fax:862-209-1106
Practice Address - Street 1:159 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3507
Practice Address - Country:US
Practice Address - Phone:973-229-3198
Practice Address - Fax:862-209-1106
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator