Provider Demographics
NPI:1073909925
Name:TARANGELO, NICHOLAS P (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:TARANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MADISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7305
Mailing Address - Country:US
Mailing Address - Phone:973-455-0404
Mailing Address - Fax:973-540-8788
Practice Address - Street 1:101 MADISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7305
Practice Address - Country:US
Practice Address - Phone:973-455-0404
Practice Address - Fax:973-540-8788
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11341500207RG0100X
PAMD462564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103254573Medicaid