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1417463977 NPI number — TARA L GRANT LAC

NPI Number: 1417463977
Health Care Provider/Practitioner: TARA L GRANT LAC

Information about “1417463977” NPI (TARA L GRANT LAC) exists in 1417463977 in HTML format HTML  |  1417463977 in plain Text format TXT  |  1417463977 in PDF (Portable Document Format) PDF  |  1417463977 in an XML format XML  formats.

NPI Number : 1417463977 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417463977",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRANT",
    "FirstName": "TARA",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3241 32ND ST # 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ASTORIA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11106-2644",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-234-7502",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "41 UNION SQ W STE 811",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10003-3265",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-566-1324",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/20/2017",
    "LastUpdateDate": "11/04/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "184115",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "007578",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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