Healthcare Provider Details

I. General information

NPI: 1932366366
Provider Name (Legal Business Name): TARA BLITZ-HERBEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA BLITZ DPM

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PLEASANT ST BLDG 1
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

2 EDGE HILL RD
SHARON MA
02067-1013
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-8000
  • Fax:
Mailing address:
  • Phone: 646-634-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00306400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2345
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006385-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: