Provider Demographics
NPI:1962408708
Name:TOMASSO, ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:TOMASSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-281-8670
Mailing Address - Fax:
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:STE 4
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-281-8670
Practice Address - Fax:631-281-8242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1853501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01358121Medicaid
NYE97331Medicare UPIN
NY01358121Medicaid