Healthcare Provider Details

I. General information

NPI: 1861876955
Provider Name (Legal Business Name): TARISAYI HOTO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 31 STE 105
FLEMINGTON NJ
08822-5812
US

IV. Provider business mailing address

5800 RIDGE AVE ROXBOROUGH MEMORIAL HOSPITAL
PHILADELPHIA PA
19128-1737
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6449
  • Fax:
Mailing address:
  • Phone: 215-483-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: