Kimberly D Tankasali, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00145300 Issued in NJ

Practice address

97 W Parkway
Pompton Plains, NJ 07444-1647

Phone

(973) 831-5446

NPI assigned

Aug 19, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Physician Associates of North Jersey P C

  • Emergency Medicine Physician
  • Summit, NJ
  • NPI 1497783419
  Medicare reassignment
• Atlantic Professional Services of New Jersey, P.a.

  • Physician Assistant
  • Stratford, NJ
  • NPI 1932145182
  NPD (past)
• Chilton Emergency Physicians LLC

  • Emergency Medicine Physician
  • Pompton Plaine, NJ
  • NPI 1346207479
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1417061870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 W PARKWAY",
            "address_2": "C/O EMERGENCY DEPARTMENT",
            "city": "POMPTON PLAINS",
            "state": "NJ",
            "postal_code": "074441647",
            "telephone_number": "973-831-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 W PARKWAY",
            "city": "POMPTON PLAINS",
            "state": "NJ",
            "postal_code": "074441647",
            "telephone_number": "973-831-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANKASALI",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "010698",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00145300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Ann Stevens, APN-C
• Joanne Roach Stickles, M.A.
• Michelle V Sucaldito
• Frederick D Sunga, PT
• Martin Yaron Tabaksblat, M.D.
• Indira Tata, MD
• Paula A Tedesco, APN
• Richard Tell
• Jennifer Thai
• Lorelane Pagulayan Tindoc, M.D.

• Medical Physician Assistant in Pompton Plains, NJ
• Providers in Pompton Plains, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.