MEDICARE: JENNIFER MARIE TARECO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XP3100X	Pediatric Orthopaedic Surgery Physician	25MA06690400	NJ

General Provider Information

NPI Number	:	1184626327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE TARECO MD

Provider Business Mailing Address
First Line	:	766 ROUTE 202/206
Second Line	:	SUITE 1
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-1777
Country	:	US
Telephone Number	:	908-722-0808
Fax Number	:	908-722-7645

Provider Business Practice Location Address
First Line	:	766 ROUTE 202/206
Second Line	:	SUITE 1
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-1777
Country	:	US
Telephone Number	:	908-722-0808
Fax Number	:	908-722-7645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/28/2017

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