Provider Demographics
NPI:1962641860
Name:TARTELL, EUGENIE (RN)
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:TARTELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAUREN CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-7207
Mailing Address - Country:US
Mailing Address - Phone:646-715-8565
Mailing Address - Fax:
Practice Address - Street 1:50 LAUREN CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-7207
Practice Address - Country:US
Practice Address - Phone:646-715-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327829-1163W00000X
NYX004881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOO4881OtherLICENSE
NYX004881OtherNY LICENSE