Provider Demographics
NPI:1841214681
Name:STILP, TARA (RPA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:STILP
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CIOFFI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPA
Mailing Address - Street 1:P.O BOX 798
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571
Mailing Address - Country:US
Mailing Address - Phone:516-705-1353
Mailing Address - Fax:
Practice Address - Street 1:1000 N. VILLAGE AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11571
Practice Address - Country:US
Practice Address - Phone:516-705-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant