Provider Demographics
NPI:1093735516
Name:TARTAGLIA, MARCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:TARTAGLIA
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 1:244 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4241
Mailing Address - Country:US
Mailing Address - Phone:973-364-0888
Mailing Address - Fax:973-364-0889
Practice Address - Street 1:20 WATSESSING AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4613
Practice Address - Country:US
Practice Address - Phone:973-364-0888
Practice Address - Fax:973-364-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA052009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5165514Medicaid
NJ5165514Medicaid
NJB 58464Medicare UPIN