Provider Demographics
NPI:1558430546
Name:T.A.E.L.L.C.
Entity Type:Organization
Organization Name:T.A.E.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:TIBERIU
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-262-3001
Mailing Address - Street 1:450 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6007
Mailing Address - Country:US
Mailing Address - Phone:732-262-3001
Mailing Address - Fax:732-262-3011
Practice Address - Street 1:450 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6007
Practice Address - Country:US
Practice Address - Phone:732-262-3001
Practice Address - Fax:732-262-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty