Provider Demographics
NPI:1740842780
Name:PRESLEY, TAMAKO
Entity type:Individual
Prefix:
First Name:TAMAKO
Middle Name:
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD STE 401
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3722
Mailing Address - Country:US
Mailing Address - Phone:215-885-5500
Mailing Address - Fax:215-885-5501
Practice Address - Street 1:261 OLD YORK RD STE 401
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3722
Practice Address - Country:US
Practice Address - Phone:215-885-5500
Practice Address - Fax:215-885-5501
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34503601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103460043Medicaid