Healthcare Provider Details

I. General information

NPI: 1992732283
Provider Name (Legal Business Name): JEANMARIE TARI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE RD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

1050 CLOVE RD
STATEN ISLAND NY
10301-3627
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-816-3611
Mailing address:
  • Phone: 718-816-6440
  • Fax: 718-816-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: