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NPI Code Detail

MEDICARE: TARUN GANGULY DO

MEDICARE: TARUN GANGULY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianMB65193NJ
2207R00000XInternal Medicine PhysicianMB65193NJ
3207Q00000XFamily Medicine Physician25NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144259912
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARUN GANGULY DO
Provider Business Mailing Address
First Line : 3458 NEELY RD
Second Line :
City : JB MDL
State : NJ
Zip : 08641-5312
Country : US
Telephone Number : 609-754-9014
Fax Number :
Provider Business Practice Location Address
First Line : 3458 NEELY RD
Second Line :
City : JOINT BASE MDL
State : NJ
Zip : 08641-5312
Country : US
Telephone Number : 609-754-9414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2006
Last Update Date : 01/12/2022

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