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General NPI Number Information
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NPI Number | 1518911049
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Entity Type | Individual
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Provider Name | TANJILA MATIN DPM
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 109 SEVEN BRIDGES RD
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-431-0788
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Fax | 570-431-0708
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Provider Business Mailing Address
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Address Line | 32 ALEXANDRA CIR
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City | MOUNT BETHEL
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State | PA
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Zip | 18343-5781
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Country | US
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Telephone | 570-431-0788
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Fax | 570-431-0706
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00282300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00282300
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License Number State | NJ
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