Daniella Tavares
Physician Assistant in Hackensack, NJ. Individual provider (NPI-1).
NPI number1962010447
StatusActive
Last updated in NPPESNov 25, 2022
Details
- NPI
- 1962010447
- Entity type
- Individual (NPI-1)
- Name
- Daniella Tavares
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 21, 2020
- Certification date
- Nov 25, 2022
- Last updated
- Nov 25, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 025366 | NY | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363AM0700X | Physician Assistant, Medical | 25MP00618400 | NJ | |
| 363AS0400X | Physician Assistant, Surgical | – | – |
Practice location
30 Prospect AveHackensack, NJ 07601-1915
Phone 551-996-2000
Mailing address
120 President RdTownship Of Washington, NJ 07676-5226
Other practice locations
4422 3rd Ave
Bronx, NY 10457-2545
Bronx, NY 10457-2545
Phone 201-206-7789
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