Provider Demographics
NPI:1932366366
Name:BLITZ-HERBEL, TARA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:BLITZ-HERBEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:BLITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2 EDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1013
Mailing Address - Country:US
Mailing Address - Phone:646-634-5500
Mailing Address - Fax:
Practice Address - Street 1:277 PLEASANT ST BLDG 1
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:212-410-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00306400213ES0103X
MA2345213ES0103X
NYN006385-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery