Provider Demographics
NPI:1932461308
Name:DESARIO, TRICIA
Entity Type:Individual
Prefix:MISS
First Name:TRICIA
Middle Name:
Last Name:DESARIO
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 1:425 W 121ST ST APT 1106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6002
Mailing Address - Country:US
Mailing Address - Phone:845-489-0128
Mailing Address - Fax:
Practice Address - Street 1:425 W 121ST ST APT 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6002
Practice Address - Country:US
Practice Address - Phone:845-489-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist