Provider Demographics
NPI:1265072102
Name:TOMASELLO, JOHN (CRNA, APN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TOMASELLO
Suffix:
Gender:M
Credentials:CRNA, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1931
Mailing Address - Country:US
Mailing Address - Phone:908-255-8303
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD STE 1
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5668
Practice Address - Country:US
Practice Address - Phone:973-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01040100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01040100OtherAPN