Healthcare Provider Details

I. General information

NPI: 1942868898
Provider Name (Legal Business Name): TARA CAROLINA FOISSET DNP,RN,CPNP-BC,CPON,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

45 HARDING AVE
VALHALLA NY
10595-2007
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2100
  • Fax:
Mailing address:
  • Phone: 914-438-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF381714-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: