Provider Demographics
NPI:1033725536
Name:JONES, TANISHA J
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:J
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 OUTWATER LN APT 1F
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2638
Mailing Address - Country:US
Mailing Address - Phone:201-852-7273
Mailing Address - Fax:
Practice Address - Street 1:254 OUTWATER LN APT 1F
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2638
Practice Address - Country:US
Practice Address - Phone:201-852-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT85900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist