Provider Demographics
NPI:1245720010
Name:TAG 2 COLLABORATION
Entity type:Organization
Organization Name:TAG 2 COLLABORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-702-2300
Mailing Address - Street 1:103 W 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8515
Mailing Address - Country:US
Mailing Address - Phone:732-702-2300
Mailing Address - Fax:
Practice Address - Street 1:103 W 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8515
Practice Address - Country:US
Practice Address - Phone:732-702-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies