Provider Demographics
NPI:1154010064
Name:TARANTINO, LORE J
Entity type:Individual
Prefix:
First Name:LORE
Middle Name:J
Last Name:TARANTINO
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 1:3906 W BRIGANTINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-3324
Mailing Address - Country:US
Mailing Address - Phone:609-665-3461
Mailing Address - Fax:
Practice Address - Street 1:2300 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1466
Practice Address - Country:US
Practice Address - Phone:609-204-4849
Practice Address - Fax:609-383-8340
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00465100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist