Provider Demographics
NPI:1124891437
Name:OWENS-DUNMORE, TAMMY G
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:G
Last Name:OWENS-DUNMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2408
Mailing Address - Country:US
Mailing Address - Phone:973-444-5906
Mailing Address - Fax:908-325-0359
Practice Address - Street 1:15 LESLIE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1009
Practice Address - Country:US
Practice Address - Phone:973-444-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care