Provider Demographics
NPI:1912268798
Name:TABACK, ANNETTE
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:TABACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1222
Mailing Address - Country:US
Mailing Address - Phone:914-663-7070
Mailing Address - Fax:
Practice Address - Street 1:4 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1222
Practice Address - Country:US
Practice Address - Phone:914-663-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator