Provider Demographics
NPI:1952664542
Name:FRANK, TARA MERYL
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MERYL
Last Name:FRANK
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 1:26 W BROADWAY APT 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4057
Mailing Address - Country:US
Mailing Address - Phone:516-473-1912
Mailing Address - Fax:
Practice Address - Street 1:26 W BROADWAY APT 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4057
Practice Address - Country:US
Practice Address - Phone:516-473-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist