Healthcare Provider Details

I. General information

NPI: 1811557689
Provider Name (Legal Business Name): TAYLOR MICHELLE INGBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6106
US

IV. Provider business mailing address

46 MICHAEL DR
WESTFIELD NJ
07090-1113
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7432
  • Fax:
Mailing address:
  • Phone: 908-821-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: