=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245355155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA J BELSARE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3220 PEARL ST
-----------------------------------------------------
City | ENDWELL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13760-5758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-215-1705
-----------------------------------------------------
Fax | 607-304-2374
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 CRARY AVE
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-624-1775
-----------------------------------------------------
Fax | 607-203-1668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 223656
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------