Emily Takhtarov

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

26NJ15114400 Issued in NJ

Practice address

141 Route 70 E Ste B
Marlton, NJ 08053-1855

Phone

(856) 596-9057

Fax

(856) 596-0837

NPI assigned

Jul 18, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Georgetown University School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Virtua Mount Holly Hospital Hospital, Mount Holly, NJ, CCN 310057
• Virtua Willingboro Hospital Hospital, Willingboro, NJ, CCN 310061
• West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022
• Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Virtua Medical Group, PA

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1649226515
  Medicare reassignment Care Compare group NPD
• Virtua Medical Group, PA

  dba Virtua Reconstructive Orthopedics - Delran

  • Orthopaedic Surgery Physician
  • Delran, NJ
  • NPI 1841087988
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Virtua - Memorial Hospital Burlington County, Inc.

  dba Virtua Mount Holly Hospital

  • General Acute Care Hospital
  • Mount Holly, NJ
  • NPI 1134125016
  Care Compare affiliation
• Virtua - West Jersey Health System, Inc.

  • General Acute Care Hospital
  • Voorhees, NJ
  • NPI 1528064409
  Care Compare affiliation
• Virtua Our Lady of Lourdes Hospital Inc

  dba Virtua Our Lady of Lourdes Hospital

  • General Acute Care Hospital
  • Camden, NJ
  • NPI 1235134024
  Care Compare affiliation
• Virtua Willingboro Hospital Inc

  dba Virtua Health & Wellness Center

  • General Acute Care Hospital
  • Willingboro, NJ
  • NPI 1053316844
  Care Compare affiliation

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

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1659119220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 ROUTE 70 E STE B",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 ROUTE 70 E STE B",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531855",
            "telephone_number": "856-596-9057",
            "fax_number": "856-596-0837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKHTAROV",
        "first_name": "EMILY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ15114400",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR26058900",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028596",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "etakhtarov281691@directvirtua.org",
            "affiliation": "N",
            "address_1": "141 Route 70 E Ste B",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080531855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Kasey Alexis Tankelewicz, CRNP
• Tao Clinic of Acupuncture
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• Adult Health Nurse Practitioner in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Adult Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.