Healthcare Provider Details

I. General information

NPI: 1851001093
Provider Name (Legal Business Name): KATHERINE TARANTOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E MAIN ST STE 200
RIVERHEAD NY
11901-2668
US

IV. Provider business mailing address

24 HOPE CT
SELDEN NY
11784-1271
US

V. Phone/Fax

Practice location:
  • Phone: 631-538-0579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: