MEDICARE: DR. TARA NAYAK ND

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
1	175F00000X	Naturopath	000573	CT

General Provider Information

NPI Number	:	1376068007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA NAYAK ND

Provider Business Mailing Address
First Line	:	215 N 17TH ST
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-5604
Country	:	US
Telephone Number	:	732-908-9477
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 E GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3326
Country	:	US
Telephone Number	:	215-485-3427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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