Provider Demographics
NPI:1124367172
Name:TARNOW, ROBERT VINCENT (AP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VINCENT
Last Name:TARNOW
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1905
Mailing Address - Country:US
Mailing Address - Phone:315-769-7610
Mailing Address - Fax:315-769-7610
Practice Address - Street 1:172 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1905
Practice Address - Country:US
Practice Address - Phone:315-769-7610
Practice Address - Fax:315-769-7610
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3232171100000X
NY005372-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist