1275671802 NPI number — MR. ERNEST TAMAJONG NP

Table of content: MR. ERNEST TAMAJONG NP (NPI 1275671802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275671802 NPI number — MR. ERNEST TAMAJONG NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAMAJONG
Provider First Name:
ERNEST
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275671802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 WRANGLE HILL RD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-437-6833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 WRANGLE HILL RD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
BEAR
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19701-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-437-6833
Provider Business Practice Location Address Fax Number:
302-455-8550
Provider Enumeration Date:
02/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP016143 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: LP-0000155 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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