Provider Demographics
NPI:1497368955
Name:TAGGER, BATSHEVA (PAC)
Entity Type:Individual
Prefix:
First Name:BATSHEVA
Middle Name:
Last Name:TAGGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1212
Mailing Address - Country:US
Mailing Address - Phone:516-946-0166
Mailing Address - Fax:
Practice Address - Street 1:15130 82ND ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1738
Practice Address - Country:US
Practice Address - Phone:718-843-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024622363A00000X
FL9113009363A00000X
NJ25MP00605900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant