Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MB09740200 | NJ |
NPI | 1164710463 |
---|---|
Provider Name | Kevin Tabije |
First Address | Watchung, NJ 07069-4905 |
Second Address | Watchung, NJ 07069-4945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 13/09/2016 |