Healthcare Provider Details

I. General information

NPI: 1558275446
Provider Name (Legal Business Name): JOHN TANEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 STULTS RD STE 137
DAYTON NJ
08810-1549
US

IV. Provider business mailing address

1 JOHN F KENNEDY BLVD APT 38F
SOMERSET NJ
08873-6935
US

V. Phone/Fax

Practice location:
  • Phone: 732-908-2111
  • Fax:
Mailing address:
  • Phone: 732-908-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: