Provider Demographics
NPI:1679956395
Name:HALPERN, TARA (PA)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:HALPERN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FREDERICK CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2878
Mailing Address - Country:US
Mailing Address - Phone:201-953-0607
Mailing Address - Fax:
Practice Address - Street 1:616 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5024
Practice Address - Country:US
Practice Address - Phone:516-795-8446
Practice Address - Fax:516-795-2981
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY019383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant