Provider Demographics
NPI:1235451642
Name:TARIFE, EDSEL ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:ROY
Last Name:TARIFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ROUTE 59
Mailing Address - Street 2:SUITE# A1
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5005
Mailing Address - Country:US
Mailing Address - Phone:845-356-8844
Mailing Address - Fax:845-356-6060
Practice Address - Street 1:156 ROUTE 59
Practice Address - Street 2:SUITE# A1
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5005
Practice Address - Country:US
Practice Address - Phone:845-356-8844
Practice Address - Fax:845-547-2218
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052338-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice