Provider Demographics
NPI:1043856131
Name:TATA, NAOZAD JAL
Entity Type:Individual
Prefix:
First Name:NAOZAD
Middle Name:JAL
Last Name:TATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1677
Mailing Address - Country:US
Mailing Address - Phone:717-209-0091
Mailing Address - Fax:
Practice Address - Street 1:221 W HIGH ST STE 1000
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1368
Practice Address - Country:US
Practice Address - Phone:717-209-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA43153601372600000X, 376J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker