Provider Demographics
NPI:1013000728
Name:BULLERI, TAMARA ANN (PSYCHIATRIC PA-C)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ANN
Last Name:BULLERI
Suffix:
Gender:F
Credentials:PSYCHIATRIC PA-C
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:VIRGILIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHIATRIC PA-C
Mailing Address - Street 1:545 ISLAND RD STE 2B&3D
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 ISLAND RD STE 2B&3D
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2813
Practice Address - Country:US
Practice Address - Phone:201-995-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1619363A00000X
MDC03461363A00000X
NJ25MP00757100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant