Provider Demographics
NPI:1295744910
Name:HARBECK, TARA NOREEN (DPM)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:NOREEN
Last Name:HARBECK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:NOREEN
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-883-8620
Mailing Address - Fax:518-883-5653
Practice Address - Street 1:4104 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:PERTH
Practice Address - State:NY
Practice Address - Zip Code:12010-0000
Practice Address - Country:US
Practice Address - Phone:518-883-8862
Practice Address - Fax:518-883-5653
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005812213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195935Medicaid
NYUB7756Medicare UPIN
NYJ400077616Medicare PIN