Provider Demographics
NPI:1225543366
Name:MASTROPIETRO COSMI, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MASTROPIETRO COSMI
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 1:7 TALMAGE RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1500
Mailing Address - Country:US
Mailing Address - Phone:908-217-9534
Mailing Address - Fax:
Practice Address - Street 1:1114 RARITAN RD STE 4
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1334
Practice Address - Country:US
Practice Address - Phone:732-388-3828
Practice Address - Fax:732-388-3829
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70009113111N00000X
NJ38MC00535000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor