Provider Demographics
NPI:1538760814
Name:TAMBURELLO, ADAM PAUL (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:PAUL
Last Name:TAMBURELLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FOOTHILL LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4107
Mailing Address - Country:US
Mailing Address - Phone:163-125-2272
Mailing Address - Fax:
Practice Address - Street 1:4 FOOTHILL LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4107
Practice Address - Country:US
Practice Address - Phone:163-125-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program