Provider Demographics
NPI:1457084857
Name:TAYLOR, KHAYREE A
Entity Type:Individual
Prefix:
First Name:KHAYREE
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S HARRISON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1743
Mailing Address - Country:US
Mailing Address - Phone:201-452-7418
Mailing Address - Fax:
Practice Address - Street 1:85 S HARRISON ST STE 201
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1743
Practice Address - Country:US
Practice Address - Phone:201-452-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver