Provider Demographics
NPI:1558928804
Name:RODIE, TARA (MSED)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:RODIE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 E 12TH ST STE 5L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1071
Mailing Address - Country:US
Mailing Address - Phone:347-414-3138
Mailing Address - Fax:
Practice Address - Street 1:1669 E 36TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4218
Practice Address - Country:US
Practice Address - Phone:347-414-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other