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General NPI Number Information
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NPI Number | 1215080163
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Entity Type | Individual
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Provider Name | IRA D TANZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 110 MEADOWLANDS PKWY # B SUITE 302
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City | SECAUCUS
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State | NJ
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Zip | 07094-2302
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Country | US
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Telephone | 201-867-1297
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Fax | 201-867-4165
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | SADDLE RIVER
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State | NJ
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Zip | 07458-0250
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Country | US
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Telephone | 201-867-1297
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Fax | 201-867-4165
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA030534
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License Number State | NJ
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