Provider Demographics
NPI:1790533305
Name:TASE, BRIANNE CHRISTINA (MSED)
Entity type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:CHRISTINA
Last Name:TASE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TERRY RD APT 10A
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5112
Mailing Address - Country:US
Mailing Address - Phone:631-834-8641
Mailing Address - Fax:
Practice Address - Street 1:1075 PORTION RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-4205
Practice Address - Country:US
Practice Address - Phone:631-320-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist