Provider Demographics
NPI:1326359167
Name:DITOMASO, TERESA (MSED)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DITOMASO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 84TH RD
Mailing Address - Street 2:6E
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2243
Mailing Address - Country:US
Mailing Address - Phone:917-921-8993
Mailing Address - Fax:
Practice Address - Street 1:14714 84TH RD
Practice Address - Street 2:6E
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2243
Practice Address - Country:US
Practice Address - Phone:917-921-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist