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NPI Code Detail

MEDICARE: MRS. TARA L LAFAVE

MEDICARE: MRS. TARA L LAFAVE
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
1156FX1800XOptician00006019NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15391060001OTHERNYMEDICARE DME

General Provider Information

NPI Number : 1780746677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA L LAFAVE
Provider Business Mailing Address
First Line : 20 TERREL WAY
Second Line :
City : GANSEVOORT
State : NY
Zip : 12831-2435
Country : US
Telephone Number : 518-695-9438
Fax Number :
Provider Business Practice Location Address
First Line : 43 SPRING ST
Second Line :
City : SCHUYLERVILLE
State : NY
Zip : 12871-1014
Country : US
Telephone Number : 518-695-3040
Fax Number : 518-695-3150
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. TARA L LAFAVE ” Practice Location

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