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General NPI Number Information
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NPI Number | 1417061870
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Entity Type | Individual
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Provider Name | KIMBERLY D TANKASALI PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 97 W PARKWAY
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444-1647
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Country | US
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Telephone | 973-831-5446
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Fax |
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Provider Business Mailing Address
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Address Line | 97 W PARKWAY C/O EMERGENCY DEPARTMENT
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444-1647
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Country | US
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Telephone | 973-831-5930
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 010698
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00145300
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License Number State | NJ
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