Provider Demographics
NPI:1386729457
Name:TANELI, TOLGA (MD)
Entity type:Individual
Prefix:DR
First Name:TOLGA
Middle Name:
Last Name:TANELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-9317
Mailing Address - Country:US
Mailing Address - Phone:973-944-0844
Mailing Address - Fax:973-934-4344
Practice Address - Street 1:126 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-9317
Practice Address - Country:US
Practice Address - Phone:973-944-0844
Practice Address - Fax:973-934-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078797002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010234189Medicaid
TAMM8959Medicare ID - Type Unspecified
NJ010234189Medicaid