Healthcare Provider Details

I. General information

NPI: 1013911486
Provider Name (Legal Business Name): TRACI A TAMBURELLO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 STELTON RD
PISCATAWAY NJ
08854-5288
US

IV. Provider business mailing address

402 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 732-572-5950
  • Fax: 732-572-6384
Mailing address:
  • Phone: 856-782-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB07292000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: