Active NPI
Tony Tharakan, DDS
- Dentist
- Philadelphia, PA
National Provider Identifier
1629641840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS043297
- Practice address
- 2107B Cottman Ave
Philadelphia, PA 19149-1122 - Phone
- (215) 235-4060
- NPI assigned
- Jul 24, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS043297 | PA | Primary |
Addresses
Primary practice location
2107B Cottman Ave
Philadelphia, PA 19149-1122
Mailing address
591 Spruce LN
Franklin Lakes, NJ 07417-2418
Phone (201) 937-4894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS043297 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1629641840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "591 SPRUCE LN",
"city": "FRANKLIN LAKES",
"state": "NJ",
"postal_code": "074172418",
"telephone_number": "201-937-4894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2107B COTTMAN AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191491122",
"telephone_number": "215-235-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THARAKAN",
"first_name": "TONY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-24",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS043297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.