Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MA06690400 | NJ |
NPI | 1184626327 |
---|---|
Provider Name | Jennifer Marie Tareco |
First Address | Bridgewater, NJ 08807-1777 |
Second Address | Bridgewater, NJ 08807-1777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G00895 | (02) | NJ |