Provider Demographics
NPI:1972764280
Name:TOMASULO, CHERYL A (DDS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:TOMASULO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7661
Mailing Address - Country:US
Mailing Address - Phone:212-753-5250
Mailing Address - Fax:212-753-0530
Practice Address - Street 1:250 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7661
Practice Address - Country:US
Practice Address - Phone:212-753-5250
Practice Address - Fax:212-753-0530
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice