Provider Demographics
NPI:1104199801
Name:TAYLOR, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TAYLOR
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 1:69 N ARLINGTON AVE
Mailing Address - Street 2:# 404
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4160
Mailing Address - Country:US
Mailing Address - Phone:973-280-1102
Mailing Address - Fax:201-837-8719
Practice Address - Street 1:69 N ARLINGTON AVE
Practice Address - Street 2:# 404
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4160
Practice Address - Country:US
Practice Address - Phone:973-280-1102
Practice Address - Fax:201-837-8719
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No174H00000XOther Service ProvidersHealth Educator