Provider Demographics
NPI:1457314148
Name:ALGERIO-VENTO, TARA M (FNP-CS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:ALGERIO-VENTO
Suffix:
Gender:F
Credentials:FNP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WEST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-432-2004
Mailing Address - Fax:516-432-4154
Practice Address - Street 1:325 WEST PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-432-2004
Practice Address - Fax:516-432-4154
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26219Medicare UPIN
0E5851Medicare ID - Type Unspecified