Provider Demographics
NPI:1811268709
Name:UNION COUNTY UNLIMITED LLC
Entity type:Organization
Organization Name:UNION COUNTY UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASHAROFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-381-3740
Mailing Address - Street 1:300 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1312
Mailing Address - Country:US
Mailing Address - Phone:908-232-2273
Mailing Address - Fax:908-232-1439
Practice Address - Street 1:300 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1312
Practice Address - Country:US
Practice Address - Phone:908-232-2273
Practice Address - Fax:908-232-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00305100213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222074YE2UMedicare PIN