Provider Demographics
NPI:1952477986
Name:TARANTINO, DEBRA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:TARANTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MILLBURN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1718
Mailing Address - Country:US
Mailing Address - Phone:973-467-2277
Mailing Address - Fax:973-467-1317
Practice Address - Street 1:231 MILLBURN AVENUE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1718
Practice Address - Country:US
Practice Address - Phone:973-467-2277
Practice Address - Fax:973-467-1317
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07109700208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0X00NJ4000OtherHEALTHNET GROUP #
NJP2172646OtherOXFORD INDIVIDUAL #
NJJ15550OtherHEALTHNET INDIVIDUAL #
NJ2621451OtherAETNA INDIVIDUAL #
NJ0489140OtherAETNA GROUP #
NJD09142-SCE402OtherOXFORD GROUP #
NJP2172646OtherOXFORD INDIVIDUAL #
NJ0489140OtherAETNA GROUP #
NJJ15550OtherHEALTHNET INDIVIDUAL #
NJ039113AUEMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #