Provider Demographics
NPI:1639592660
Name:TRIPODI, TARA (MSED)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:TRIPODI
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 1:158 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3440
Mailing Address - Country:US
Mailing Address - Phone:516-241-1697
Mailing Address - Fax:
Practice Address - Street 1:158 WAYNE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3440
Practice Address - Country:US
Practice Address - Phone:516-241-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist