Healthcare Provider Details

I. General information

NPI: 1073502647
Provider Name (Legal Business Name): JANINE G TABAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALNUT ST SUITE 210W
PHILADELPHIA PA
19106-3323
US

IV. Provider business mailing address

601 WALNUT ST SUITE 210W
PHILADELPHIA PA
19106-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-925-6402
  • Fax: 215-925-0262
Mailing address:
  • Phone: 215-925-6402
  • Fax: 215-925-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD046158L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: