Healthcare Provider Details

I. General information

NPI: 1376068007
Provider Name (Legal Business Name): TARA NAYAK ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E GIRARD AVE
PHILADELPHIA PA
19125-3326
US

IV. Provider business mailing address

215 N 17TH ST
ALLENTOWN PA
18104-5604
US

V. Phone/Fax

Practice location:
  • Phone: 215-485-3427
  • Fax:
Mailing address:
  • Phone: 732-908-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000573
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: