Provider Demographics
NPI:1235204975
Name:FALLS, INGRID TAINA (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:TAINA
Last Name:FALLS
Suffix:
Gender:F
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:PO BOX 3000
Mailing Address - Street 2:PESS
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1262
Mailing Address - Country:US
Mailing Address - Phone:908-526-2922
Mailing Address - Fax:908-218-0466
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-526-2922
Practice Address - Fax:908-218-0466
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0508952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1407054406OtherAGENCY NPI #
NJ0133132Medicaid
NJE53685Medicare UPIN