Healthcare Provider Details

I. General information

NPI: 1851977136
Provider Name (Legal Business Name): TARA CUETER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BENKERT ST
BETHPAGE NY
11714-3002
US

IV. Provider business mailing address

149 SULLIVAN AVE
FARMINGDALE NY
11735-5022
US

V. Phone/Fax

Practice location:
  • Phone: 516-490-9085
  • Fax:
Mailing address:
  • Phone: 516-242-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: