1952477986 NPI number — DR. DEBRA R TARANTINO M.D.

Table of content: DR. DEBRA R TARANTINO M.D. (NPI 1952477986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952477986 NPI number — DR. DEBRA R TARANTINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARANTINO
Provider First Name:
DEBRA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1952477986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 MILLBURN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLBURN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07041-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-467-2277
Provider Business Mailing Address Fax Number:
973-467-1317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 MILLBURN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLBURN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07041-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-467-2277
Provider Business Practice Location Address Fax Number:
973-467-1317
Provider Enumeration Date:
11/28/2006

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: 208C00000X , with the licence number:  25MA07109700 , 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)

  • Identifier: 0X00NJ4000 . This is a "HEALTHNET GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2172646 . This is a "OXFORD INDIVIDUAL #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J15550 . This is a "HEALTHNET INDIVIDUAL #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2621451 . This is a "AETNA INDIVIDUAL #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0489140 . This is a "AETNA GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: D09142-SCE402 . This is a "OXFORD GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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