Provider Demographics
NPI:1275966251
Name:BERISHA, TAMARA JOY (LAC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JOY
Last Name:BERISHA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JOY
Other - Last Name:TELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:301 HUNT DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-1856
Mailing Address - Country:US
Mailing Address - Phone:908-391-0092
Mailing Address - Fax:
Practice Address - Street 1:215 ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5752
Practice Address - Country:US
Practice Address - Phone:908-788-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00034300171100000X
NH178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist