Provider Demographics
NPI:1619254091
Name:TAHIRA, NUSRAT
Entity Type:Individual
Prefix:
First Name:NUSRAT
Middle Name:
Last Name:TAHIRA
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 1:655 84TH ST
Mailing Address - Street 2:655 84TH STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2819
Mailing Address - Country:US
Mailing Address - Phone:917-363-3317
Mailing Address - Fax:
Practice Address - Street 1:655 84TH ST
Practice Address - Street 2:655 84TH STREET
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2819
Practice Address - Country:US
Practice Address - Phone:917-363-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930982058OtherGHI