Provider Demographics
NPI:1184626327
Name:TARECO, JENNIFER MARIE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:TARECO
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 1:766 ROUTE 202/206
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1777
Mailing Address - Country:US
Mailing Address - Phone:908-722-0808
Mailing Address - Fax:908-722-7645
Practice Address - Street 1:766 ROUTE 202/206
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1777
Practice Address - Country:US
Practice Address - Phone:908-722-0808
Practice Address - Fax:908-722-7645
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06690400207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG00895Medicare UPIN
027101ASGMedicare PIN