Healthcare Provider Details

I. General information

NPI: 1134580772
Provider Name (Legal Business Name): TARA HERLOCHER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W 157TH ST
NEW YORK NY
10032-7601
US

IV. Provider business mailing address

60 MADISON AVE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 212-781-7979
  • Fax: 212-781-7963
Mailing address:
  • Phone: 866-246-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: