Provider Demographics
NPI:1649531534
Name:PROBST, TRESSA (TVI)
Entity type:Individual
Prefix:MRS
First Name:TRESSA
Middle Name:
Last Name:PROBST
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:MISS
Other - First Name:TRESSA
Other - Middle Name:
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TVI
Mailing Address - Street 1:10 EVANS CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2819
Mailing Address - Country:US
Mailing Address - Phone:631-553-0141
Mailing Address - Fax:
Practice Address - Street 1:10 EVANS CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2819
Practice Address - Country:US
Practice Address - Phone:631-547-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17440000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist