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General NPI Number Information
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NPI Number | 1104906015
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Entity Type | Individual
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Provider Name | TAMAR RUTH KALLUS OD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 106 FERRY ST
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City | NEWARK
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State | NJ
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Zip | 07105-2106
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Country | US
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Telephone | 973-589-8085
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Fax | 973-589-2891
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Provider Business Mailing Address
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Address Line | 335 MAPLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3705
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Country | US
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Telephone | 201-837-2061
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Fax | 201-837-2061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OA 005755
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License Number State | NJ
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