Provider Demographics
NPI:1245591015
Name:TANEN, RICKI W (MS SP ED)
Entity Type:Individual
Prefix:MRS
First Name:RICKI
Middle Name:W
Last Name:TANEN
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3407
Mailing Address - Country:US
Mailing Address - Phone:516-538-5165
Mailing Address - Fax:
Practice Address - Street 1:792 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3407
Practice Address - Country:US
Practice Address - Phone:516-538-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1872763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist