Provider Demographics
NPI:1922030642
Name:ROSSOMANDO, TAMMY JO (MED, ATC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JO
Last Name:ROSSOMANDO
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2818
Mailing Address - Country:US
Mailing Address - Phone:201-722-1959
Mailing Address - Fax:
Practice Address - Street 1:166 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2818
Practice Address - Country:US
Practice Address - Phone:201-722-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000464002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer