Provider Demographics
NPI:1528646254
Name:TAMBOLI, PANKTI (DO)
Entity type:Individual
Prefix:DR
First Name:PANKTI
Middle Name:
Last Name:TAMBOLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:134 BRIDGETON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2616
Mailing Address - Country:US
Mailing Address - Phone:856-507-2783
Mailing Address - Fax:856-221-4138
Practice Address - Street 1:1450 ALMONESSON RD STE 225
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5241
Practice Address - Country:US
Practice Address - Phone:856-227-8611
Practice Address - Fax:856-227-5716
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB12082300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine