Healthcare Provider Details

I. General information

NPI: 1326760919
Provider Name (Legal Business Name): REGINA M TART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 BELLE TERRE RD
PORT JEFFERSON NY
11777-1936
US

IV. Provider business mailing address

14 CHURCH LN
MIDDLE ISLAND NY
11953-1706
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-5361
  • Fax:
Mailing address:
  • Phone: 631-905-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: