Provider Demographics
NPI:1396577417
Name:PETER TAH MD PA LLC
Entity type:Organization
Organization Name:PETER TAH MD PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNED
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-811-5391
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07543-0406
Mailing Address - Country:US
Mailing Address - Phone:973-405-6333
Mailing Address - Fax:
Practice Address - Street 1:424 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2645
Practice Address - Country:US
Practice Address - Phone:888-811-5391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty