Healthcare Provider Details

I. General information

NPI: 1164094553
Provider Name (Legal Business Name): KRISTIAN TARONG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 OAK TREE AVE
SOUTH PLAINFIELD NJ
07080-5100
US

IV. Provider business mailing address

1744 E 2ND ST
SCOTCH PLAINS NJ
07076-1708
US

V. Phone/Fax

Practice location:
  • Phone: 732-603-1655
  • Fax: 732-307-0783
Mailing address:
  • Phone: 908-312-9340
  • Fax: 908-322-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00782200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: