Individual
DANIELLA TAVARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2000
Mailing address
120 PRESIDENT RD, TOWNSHIP OF WASHINGTON, NJ 07676-5226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025366
NY
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
25MP00618400
NJ
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/21/2020
Last updated
11/25/2022
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