Provider Demographics
NPI:1700288123
Name:ALMQUIST, TARA (LAC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ALMQUIST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DAVID RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3009
Mailing Address - Country:US
Mailing Address - Phone:646-483-3086
Mailing Address - Fax:
Practice Address - Street 1:361 ROUTE 202
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3206
Practice Address - Country:US
Practice Address - Phone:646-483-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist