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General NPI Number Information
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NPI Number | 1326186768
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Entity Type | Organization
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Legal Business Name | TARA P. KANETKAR, MD, PA
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 2149 WOODBRIDGE AVE
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City | EDISON
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State | NJ
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Zip | 08817-4474
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Country | US
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Telephone | 732-985-2151
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Fax | 732-985-0650
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Provider Business Mailing Address
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Address Line | 2149 WOODBRIDGE AVE
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City | EDISON
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State | NJ
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Zip | 08817-4474
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Country | US
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Telephone | 732-985-2151
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Fax | 732-985-0650
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Authorized Official
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Title or Position | OWNER
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Name | TARA P KANETKAR
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Credential | MD
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Telephone | 732-985-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA023527
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License Number State | NJ
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