Provider Demographics
NPI:1902862543
Name:TARIFE, ELLERY (NP)
Entity Type:Individual
Prefix:MR
First Name:ELLERY
Middle Name:
Last Name:TARIFE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOBART AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1405
Mailing Address - Country:US
Mailing Address - Phone:845-641-4634
Mailing Address - Fax:
Practice Address - Street 1:9 HOBART AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1405
Practice Address - Country:US
Practice Address - Phone:845-641-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00143800363LF0000X, 363LP0808X
NYF333998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139890XVAMedicare UPIN
NY0944G1Medicare PIN