Provider Demographics
NPI:1205872785
Name:TAGAYUN, MYRNA B (MD)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:B
Last Name:TAGAYUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1199 MAIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2253
Mailing Address - Country:US
Mailing Address - Phone:973-253-7737
Mailing Address - Fax:973-253-0213
Practice Address - Street 1:1199 MAIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2253
Practice Address - Country:US
Practice Address - Phone:973-253-7737
Practice Address - Fax:973-253-0213
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA0477500002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63821Medicare UPIN