Provider Demographics
NPI:1487011235
Name:ROBERTSON, TARA E
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:E
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:E
Other - Last Name:FEHRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2318
Mailing Address - Country:US
Mailing Address - Phone:516-298-4820
Mailing Address - Fax:
Practice Address - Street 1:35 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2318
Practice Address - Country:US
Practice Address - Phone:516-298-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist