Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00782200 | NJ |
NPI | 1164094553 |
---|---|
Provider Name | Kristian Tarong |
First Address | Scotch Plains, NJ 07076-1708 |
Second Address | South Plainfield, NJ 07080-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |