Provider Demographics
NPI:1952695678
Name:TATARSKY, DINA (SLP MS CFY)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:TATARSKY
Suffix:
Gender:F
Credentials:SLP MS CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GARSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2461
Mailing Address - Country:US
Mailing Address - Phone:973-652-0003
Mailing Address - Fax:
Practice Address - Street 1:230 GARSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2461
Practice Address - Country:US
Practice Address - Phone:973-652-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL1954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist