Individual
KIMBERLY D TANKASALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
97 W PARKWAY, POMPTON PLAINS, NJ 07444-1647
(973) 831-5446
Mailing address
97 W PARKWAY, C/O EMERGENCY DEPARTMENT, POMPTON PLAINS, NJ 07444-1647
(973) 831-5930
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
010698
NY
363AM0700X
Medical Physician Assistant
Primary
25MP00145300
NJ
Other
Enumeration date
08/19/2006
Last updated
10/02/2012
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