Provider Demographics
NPI:1861466336
Name:TOMASELLO, DEAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
Last Name:TOMASELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 AVENUE OF TWO RIVERS
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1802
Mailing Address - Country:US
Mailing Address - Phone:732-492-1142
Mailing Address - Fax:732-224-9940
Practice Address - Street 1:112 AVENUE OF TWO RIVERS
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1802
Practice Address - Country:US
Practice Address - Phone:732-492-1142
Practice Address - Fax:732-224-9940
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08040900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099612Medicare PIN
WIF96319Medicare UPIN