Provider Demographics
NPI:1548578958
Name:JAMES P TAITSMAN MD PA
Entity Type:Organization
Organization Name:JAMES P TAITSMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:609-896-0707
Mailing Address - Street 1:123 FRANKLIN CORNER RD
Mailing Address - Street 2:114
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2526
Mailing Address - Country:US
Mailing Address - Phone:609-896-0707
Mailing Address - Fax:609-896-2227
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:114
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:609-896-0707
Practice Address - Fax:609-896-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03170300207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0131903Medicaid
NJ1012950001Medicare NSC
NJ0131903Medicaid