Provider Demographics
NPI:1720404254
Name:MAJ, TARA L
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:MAJ
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 1:8684 LAPP RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9350
Mailing Address - Country:US
Mailing Address - Phone:716-741-3734
Mailing Address - Fax:
Practice Address - Street 1:6395 OLD NIAGARA RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1421
Practice Address - Country:US
Practice Address - Phone:716-433-9592
Practice Address - Fax:716-433-3464
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist