Provider Demographics
NPI:1306937172
Name:TAITEL, JANICE BETH (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:BETH
Last Name:TAITEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1001
Mailing Address - Country:US
Mailing Address - Phone:973-586-4640
Mailing Address - Fax:
Practice Address - Street 1:17 S WARREN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4506
Practice Address - Country:US
Practice Address - Phone:973-328-9100
Practice Address - Fax:973-328-6817
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06116100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0013676Medicaid
NJ0038750Medicaid
NJ0013676Medicaid