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General NPI Number Information
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NPI Number | 1295085744
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Entity Type | Individual
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Provider Name | TAMAR M LADERMAN RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 104 PLAIN HILL RD
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City | BALTIC
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State | CT
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Zip | 06330-1051
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Country | US
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Telephone | 860-464-4170
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Fax |
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Provider Business Mailing Address
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Address Line | 10 RIVER RD APT 11M
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City | NEW YORK
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State | NY
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Zip | 10044-1148
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Country | US
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Telephone | 908-794-5643
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337157
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 623796-1
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License Number State | NY
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