Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DI01790300 | NJ |
N | 122300000X | Dentist | DS029630L | PA |
NPI | 1003912791 |
---|---|
Provider Name | Dr. Jerome Tummillo |
First Address | Voorhees, NJ 08043-4672 |
Second Address | Whitehouse Station, NJ 08889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |