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General NPI Number Information
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NPI Number | 1043428147
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Entity Type | Individual
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Provider Name | MARK ALAN TATAR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 726 COLUMBIA TPKE
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City | EAST GREENBUSH
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State | NY
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Zip | 12061-2215
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Country | US
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Telephone | 518-674-0528
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Fax | 518-674-0528
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Provider Business Mailing Address
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Address Line | 9 CAYUGA CT
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City | AVERILL PARK
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State | NY
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Zip | 12018-9672
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Country | US
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Telephone | 518-674-0528
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Fax | 518-674-0528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 009456
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License Number State | NY
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