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General NPI Number Information
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NPI Number | 1417210394
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Entity Type | Individual
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Provider Name | TANIA AFONSO D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2012
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 75 E NORTHFIELD RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4532
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Country | US
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Telephone | 973-436-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 265446-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MB09251300
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License Number State | NJ
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