Provider Demographics
NPI:1295085744
Name:LADERMAN, TAMAR M (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:TAMAR
Middle Name:M
Last Name:LADERMAN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RIVER RD APT 11M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-1148
Mailing Address - Country:US
Mailing Address - Phone:908-794-5643
Mailing Address - Fax:
Practice Address - Street 1:104 PLAIN HILL RD
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:CT
Practice Address - Zip Code:06330-1051
Practice Address - Country:US
Practice Address - Phone:860-464-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337157363LF0000X
NY623796-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse