Basic Information
| Provider Information | |||||||||
| NPI: | 1235149766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALIFEROVA | ||||||||
| FirstName: | TATYANA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080161343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093872142 | ||||||||
| FaxNumber: | 6093872757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA07644300 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 25MA07644300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.