Individual
JULIE I TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
42 ASHTON RD, MEDFORD, NY 11763-1002
(631) 334-3520
Mailing address
42 ASHTON RD, MEDFORD, NY 11763-1002
(631) 334-3520
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
—
—
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-1025305
SOLE PROP
NY
05
—
81-1025305
—
NY
Enumeration date
05/17/2019
Last updated
05/17/2019
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