Provider Demographics
NPI:1548462377
Name:TARASENKO, TONY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:JOHN
Last Name:TARASENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 KENT PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4708
Mailing Address - Country:US
Mailing Address - Phone:908-277-2135
Mailing Address - Fax:
Practice Address - Street 1:116 CORPORATE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2437
Practice Address - Country:US
Practice Address - Phone:908-757-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05013400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTA196931Medicare ID - Type Unspecified
NJE82879Medicare UPIN