Provider Demographics
NPI:1235628850
Name:TACK, VALENTYNA (DO)
Entity Type:Individual
Prefix:
First Name:VALENTYNA
Middle Name:
Last Name:TACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:973-325-1115
Mailing Address - Fax:973-325-1186
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 105
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1080
Practice Address - Country:US
Practice Address - Phone:973-325-1115
Practice Address - Fax:973-325-1186
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO035019208000000X
NJ25MB11903400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics