Provider Demographics
NPI:1508114216
Name:SCHWARTZ, TARAH E (MA)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:E
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MEROKE TRL
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2116
Mailing Address - Country:US
Mailing Address - Phone:631-707-2326
Mailing Address - Fax:
Practice Address - Street 1:41 YAPHANK MIDDLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2369
Practice Address - Country:US
Practice Address - Phone:631-345-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023021-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023021-1OtherSPEECH LANGUAGE PATHOLOGY PROFESSIONAL LICENSE