Healthcare Provider Details

I. General information

NPI: 1568380160
Provider Name (Legal Business Name): KATHERINE TADROS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S WHITE HORSE PIKE FL 2
AUDUBON NJ
08106-1326
US

IV. Provider business mailing address

722 S WHITE HORSE PIKE FL 2
AUDUBON NJ
08106-1326
US

V. Phone/Fax

Practice location:
  • Phone: 862-226-8138
  • Fax:
Mailing address:
  • Phone: 862-226-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: