Provider Demographics
NPI:1770838286
Name:BRINKMANN, TARA ANN (MSED)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:BRINKMANN
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 1:96 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2629
Mailing Address - Country:US
Mailing Address - Phone:516-798-0938
Mailing Address - Fax:516-798-0938
Practice Address - Street 1:96 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2629
Practice Address - Country:US
Practice Address - Phone:516-798-0938
Practice Address - Fax:516-798-0938
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY821689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist