Healthcare Provider Details

I. General information

NPI: 1174536668
Provider Name (Legal Business Name): TARA HERWITZ ROFFE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 ATLANTIC AVE STE 1
EAST ROCKAWAY NY
11518
US

IV. Provider business mailing address

433 ATLANTIC AVE STE 1
EAST ROCKAWAY NY
11518
US

V. Phone/Fax

Practice location:
  • Phone: 516-823-9211
  • Fax: 516-823-9212
Mailing address:
  • Phone: 516-823-9211
  • Fax: 516-823-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: