Provider Demographics
NPI:1235163544
Name:DIRECTOR, TARA D (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:D
Last Name:DIRECTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 GREENWICH ST
Mailing Address - Street 2:APARTMENT 3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:917-536-1142
Mailing Address - Fax:
Practice Address - Street 1:16TH ST AT 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2898
Practice Address - Fax:212-420-2115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241475207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00760812Medicare PIN
NYA400007762Medicare PIN
NYA400001187Medicare PIN