1811278906 NPI number — MS. CRISTINA R TAVAREZ MS, PA-C

Table of content: MS. CRISTINA R TAVAREZ MS, PA-C (NPI 1811278906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811278906 NPI number — MS. CRISTINA R TAVAREZ MS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAVAREZ
Provider First Name:
CRISTINA
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, PA-C
Provider Gender Code:
F

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:
1811278906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 MOUNT PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07104-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-483-3640
Provider Business Mailing Address Fax Number:
973-483-4895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 MOUNT PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-483-3640
Provider Business Practice Location Address Fax Number:
973-483-4895
Provider Enumeration Date:
09/01/2011

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: 363AM0700X , with the licence number:  25MP00265700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 25MP00265700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com