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NPI Code Detail

MEDICARE: MS. TARA ELLEN FAY FNP-BC

MEDICARE: MS. TARA ELLEN FAY FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF349074NY

General Provider Information

NPI Number : 1114679784
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA ELLEN FAY FNP-BC
Provider Business Mailing Address
First Line : 711 TROY SCHENECTADY RD STE 203
Second Line :
City : LATHAM
State : NY
Zip : 12110-2461
Country : US
Telephone Number : 518-782-3700
Fax Number : 518-782-3799
Provider Business Practice Location Address
First Line : 14 VISTA BLVD
Second Line :
City : SLINGERLANDS
State : NY
Zip : 12159-2184
Country : US
Telephone Number : 518-459-5273
Fax Number : 518-489-5790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2022
Last Update Date : 03/02/2022

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