Individual
TARA ROSE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 W MAIN ST, BAY SHORE, NY 11706-8314
(860) 373-6289
Mailing address
11 W MAIN ST # 5-313, PATCHOGUE, NY 11772-3087
(860) 373-6289
(860) 373-6289
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
220311
NY
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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