Provider Demographics
NPI:1477757250
Name:PUA, TARAH LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:TARAH
Middle Name:LEIGH
Last Name:PUA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-3410
Mailing Address - Fax:
Practice Address - Street 1:11205 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8311
Practice Address - Country:US
Practice Address - Phone:187-303-3725
Practice Address - Fax:718-886-4251
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245954207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03099772Medicaid
NYA400052605Medicare PIN