Healthcare Provider Details

I. General information

NPI: 1780668764
Provider Name (Legal Business Name): PHILIP TASCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND AVE FIRST FLOOR
ENGLEWOOD NJ
07631-4967
US

IV. Provider business mailing address

500 GRAND AVE FIRST FLOOR
ENGLEWOOD NJ
07631-4967
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • Fax: 201-567-7506
Mailing address:
  • Phone: 201-567-2277
  • Fax: 201-567-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07872400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2355541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: