Provider Demographics
NPI:1447799838
Name:FATIC, TAMARA
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:FATIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MAIN ST
Mailing Address - Street 2:APT1010
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0141
Mailing Address - Country:US
Mailing Address - Phone:718-496-5093
Mailing Address - Fax:
Practice Address - Street 1:171 MADISON AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:718-496-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula