Provider Demographics
NPI:1770846651
Name:TOMALA, DOUGLAS RICHARD (MS ED)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:RICHARD
Last Name:TOMALA
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BLEECKER ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3802
Mailing Address - Country:US
Mailing Address - Phone:917-853-4792
Mailing Address - Fax:
Practice Address - Street 1:16 BLEECKER ST
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3802
Practice Address - Country:US
Practice Address - Phone:917-853-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist