Tarasov, Ethan A

Tarasov, Ethan A is an individual health care provider with primary practice located at 2501 Kuser Rd , Hamilton NJ 08691-3302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Tarasov, Ethan A can be contacted via phone (609) 585-8800.

Contact Information

Primary practice address
2501 Kuser Rd Hamilton NJ 08691-3302
Fax: (609) 585-1825
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MA04785400 New Jersey
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD035415-E Pennsylvania

Profile Details

NPI number 1760488068
LBN Legal business name Tarasov, Ethan A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Aug 24th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760488068 NPPES
New Jersey MEDICAID 7345607
New Jersey MEDICAID 01536103

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