Provider Demographics
NPI:1427690999
Name:JOSEPH, TIARRA TANAE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:TIARRA
Middle Name:TANAE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5126
Mailing Address - Country:US
Mailing Address - Phone:862-755-5850
Mailing Address - Fax:
Practice Address - Street 1:122 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2081
Practice Address - Country:US
Practice Address - Phone:908-298-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002603002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer