Healthcare Provider Details

I. General information

NPI: 1447799838
Provider Name (Legal Business Name): MRS. TAMARA FATIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MADISON AVE SUITE 1000
NEW YORK NY
10016-5110
US

IV. Provider business mailing address

540 MAIN ST APT1010
NEW YORK NY
10044-0141
US

V. Phone/Fax

Practice location:
  • Phone: 718-496-5093
  • Fax:
Mailing address:
  • Phone: 718-496-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: