Provider Demographics
NPI:1073582532
Name:TAFA CORPORATION
Entity Type:Organization
Organization Name:TAFA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FATTOROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-663-1892
Mailing Address - Street 1:48 W SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2940
Mailing Address - Country:US
Mailing Address - Phone:973-663-1892
Mailing Address - Fax:973-663-5758
Practice Address - Street 1:48 W SHAWNEE TRL
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2940
Practice Address - Country:US
Practice Address - Phone:973-663-1892
Practice Address - Fax:973-663-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherUNITEDHEALTHCARE
NJ0535870001Medicare ID - Type Unspecified