Doctor Name: | LUCY TASHAROFI |
NPI Number: | 1205087202 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 25MP00091100 |
Business Practice Address: | 115 North Ave Hillside, NJ - 072053113 |
Business Phone Number: | 9083544371 |
Business Fax Number: | 9083549300 |
Mailing Address: | 999 Raritan Rd, CLARK |
State: | NJ |
Postal Code: | 070661757 |
Phone Number: | 7323819418 |
Fax Number: | 7323813733 |
NPI Enumeration Date: | 10/08/2008 |
NPI Last Update Date: | 10/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 25MP00091100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |