Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 25MA10805000 | NJ |
Y | 213ES0000X | Sports Medicine | 25MA10805000 | NJ |
N | 2081S0010X | Sports Medicine | ME150036 | FL |
N | 213ES0000X | Sports Medicine | ME150036 | FL |
NPI | 1164877064 |
---|---|
Provider Name | Dr. Peter Vincent Tumminelli JR. |
First Address | Staten Island, NY 10305-3436 |
Second Address | Staten Island, NY 10305-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 25/01/2022 |