Individual
DR. TEJ PHATAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 926-6668
Mailing address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 926-6668
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA07894300
NJ
2085P0229X
Pediatric Radiology Physician
Primary
25MA07894300
NJ
Other
Enumeration date
07/21/2008
Last updated
10/07/2015
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