Healthcare Provider Details

I. General information

NPI: 1528500808
Provider Name (Legal Business Name): MICHELLE TAMAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 FORT WASHINGTON AVENUE SUITE B
NEW YORK NY
10040-1131
US

IV. Provider business mailing address

300 WIERIMUS RD
HILLSDALE NJ
07642-1133
US

V. Phone/Fax

Practice location:
  • Phone: 646-496-6240
  • Fax:
Mailing address:
  • Phone: 646-496-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421226-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number421226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: