Provider Demographics
NPI:1326207085
Name:DELAURENTIIS, TATIANA S (DPM)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:S
Last Name:DELAURENTIIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3111
Mailing Address - Country:US
Mailing Address - Phone:908-222-0798
Mailing Address - Fax:
Practice Address - Street 1:969 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3111
Practice Address - Country:US
Practice Address - Phone:908-222-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00296400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery