Healthcare Provider Details

I. General information

NPI: 1487453536
Provider Name (Legal Business Name): TAMIKA M MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 IRVINGTON AVE
SOUTH ORANGE NJ
07079-1904
US

IV. Provider business mailing address

8 ACME ST
BELLEVILLE NJ
07109-3507
US

V. Phone/Fax

Practice location:
  • Phone: 973-395-5830
  • Fax:
Mailing address:
  • Phone: 201-658-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: