1013129469 NPI number — MS. TAMARA JEAN GREEN-DACHINGER TAMARA

Table of content: MS. TAMARA JEAN GREEN-DACHINGER TAMARA (NPI 1013129469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013129469 NPI number — MS. TAMARA JEAN GREEN-DACHINGER TAMARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN-DACHINGER
Provider First Name:
TAMARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
TAMARA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
TAMARA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
TAMARA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013129469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 CROSSWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583-7204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-722-8301
Provider Business Mailing Address Fax Number:
914-517-1337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 5TH AVE
Provider Second Line Business Practice Location Address:
#8C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-7604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-420-4047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  044722-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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