Basic Information
| Provider Information | |||||||||
| NPI: | 1548462377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARASENKO | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 KENT PLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079014708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082772135 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 116 CORPORATE BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | SOUTH PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070802437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087571424 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA05013400 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.