| Tara P. Kanetkar, MD, PA | |
|
2149 Woodbridge Ave Edison NJ 08817-4474 | |
| (732) 985-2151 | |
| (732) 985-0650 |
| Full Name | Tara P. Kanetkar, MD, PA |
|---|---|
| Speciality | Family Medicine |
| Location | 2149 Woodbridge Ave, Edison, New Jersey |
| Authorized Official Name and Position | Tara P Kanetkar (OWNER) |
| Authorized Official Contact | 7329852151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara P. Kanetkar, MD, PA 2149 Woodbridge Ave Edison NJ 08817-4474 Ph: (732) 985-2151 | Tara P. Kanetkar, MD, PA 2149 Woodbridge Ave Edison NJ 08817-4474 Ph: (732) 985-2151 |
| NPI Number | 1326186768 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 09/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326186768 | NPI | - | NPPES |
| 2091704 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MA023527 (New Jersey) | Primary |
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