Provider Demographics
NPI:1104955012
Name:TSOMBARIS, DIANA SOPHIA (DPM)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SOPHIA
Last Name:TSOMBARIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:TSOMBARIS
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:119 BERKLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1161
Mailing Address - Country:US
Mailing Address - Phone:856-599-0133
Mailing Address - Fax:833-234-1751
Practice Address - Street 1:119 BERKLEY RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08020-1161
Practice Address - Country:US
Practice Address - Phone:856-599-0133
Practice Address - Fax:833-234-1751
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00299300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery