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General NPI Number Information
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NPI Number | 1285890293
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Entity Type | Individual
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Provider Name | TATIANA D. DELL'AQUILA P.A.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 339 PASSAIC AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-2738
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Country | US
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Telephone | 973-542-2880
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Fax | 973-542-2881
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Provider Business Mailing Address
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Address Line | 339 PASSAIC AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-2738
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Country | US
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Telephone | 973-542-2880
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Fax | 973-542-2881
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00199600
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License Number State | NJ
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