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General NPI Number Information
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NPI Number | 1154010064
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Entity Type | Individual
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Provider Name | LORE J TARANTINO
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Gender | Female
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 2300 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1466
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Country | US
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Telephone | 609-204-4849
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Fax | 609-383-8340
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Provider Business Mailing Address
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Address Line | 3906 W BRIGANTINE AVE
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City | BRIGANTINE
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State | NJ
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Zip | 08203-3324
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Country | US
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Telephone | 609-665-3461
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00465100
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License Number State | NJ
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