Provider Demographics
NPI:1740897792
Name:MEALEY, TABATHA ANN (MAS)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:ANN
Last Name:MEALEY
Suffix:
Gender:F
Credentials:MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3516
Mailing Address - Country:US
Mailing Address - Phone:973-703-1408
Mailing Address - Fax:
Practice Address - Street 1:198 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1892
Practice Address - Country:US
Practice Address - Phone:973-703-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care