Healthcare Provider Details

I. General information

NPI: 1598901027
Provider Name (Legal Business Name): TARA C FORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275-277 FOREST AVE STE 125
PARAMUS NJ
07652-5423
US

IV. Provider business mailing address

18 EAGLE TER
WEST ORANGE NJ
07052-5006
US

V. Phone/Fax

Practice location:
  • Phone: 551-278-5898
  • Fax:
Mailing address:
  • Phone: 631-766-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00651000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: