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General NPI Number Information
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NPI Number | 1992746242
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Entity Type | Individual
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Provider Name | SUSAN TAMAGNI PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 17 W RED BANK AVE STE 201
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City | WOODBURY
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State | NJ
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Zip | 08096-1630
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Country | US
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Telephone | 856-536-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST # 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 856-356-4924
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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 | MA-002428-L
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License Number State | PA
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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 | 25MP00032600
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License Number State | NJ
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